CUSHING'S SYNDROME

iatrogenic [steroid treatment; commonest cause; low ACTH]

Cushing's disease [high ACTH; cortisol suppressed with high-dose dexa, but not low-dose]:

pituitary adenoma

hyperplasia of ACTH-producing cells

adrenal tumours [low / undetectable ACTH; cortisol not suppressed with high-dose dexa]:

adenoma

carcinoma

adrenal hyperplasia [cortisol suppressed with low-dose dexa]

ectopic ACTH production [very high ACTH; pigmentation much more prominent; usually paraneoplastic syndrome caused by bronchial carcinoma (esp. oat cell); also thymus, ovary, pancreas, thyroid]

pseudo-Cushing's syndrome in alcoholic liver disease

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