Now that I’ve caught your attention with my catchy title I can introduce myself and get this show on the road. Hi I’m Georgie and I will be introducing you to a number of different diseases, disorders and diagnostic tests in each issue. Before I start I am not a doctor nor do I have any training in the medical field, I am just a person that is interested in medicine and anything relating to the human body.
Cushing’s is a hormonal disorder caused by prolonged exposure of the body’s tissues to high levels of the hormone cortisol from a variety of causes including pituitary adenoma, adrenal hyperplasia or neoplasia, ectopic adrenocorticotropic hormone (ACTH) production and iatrogenic (steroid use).
Cortisol performs vital tasks in the body. It helps maintain blood pressure and cardiovascular function, reduces immune system’s inflammatory response, balances effects of insulin and regulates the metabolism of fats, proteins and carbohydrates. Cortisol’s most important job is to help the body respond to stress. Women in the last 3 months of pregnancy, high performance athletes and people suffering from depression, alcoholism, malnutrition and panic disorders have increased levels of cortisol.
Symptoms include often upper body obesity, rounded face, increased fat around neck and thinning arms/legs. The skin becomes fragile, thin, bruises easily and heals poorly. Purplish stretch marks appear on abdomen, thighs, buttocks, arms and breasts; also weakened bones, fatigue, weakness, high blood pressure and high blood sugar.
Treatment options include surgery to remove the pituitary adenoma, radiation, chemotherapy and cortisol inhibiting drugs.
It’s time for an exciting scene from episode 209 “Deception”. In this episode Cushing’s is mentioned and is considered for the differential diagnosis. We join the team back in the diagnostics office after House has just mangled Anica’s LP for the next differential diagnosis.
House: At the risk of sounding redundant, and right, again, she has Cushing’s. Cushing’s.
Foreman: Right, the fact that you mangled her LP has nothing to do with it.
House: Actually, it has everything to do with it. Cushing’s plus stress equals hypertensive crisis. Smart move, sending the rookie.
Foreman: Her initial symptoms could have been caused by alcohol-induced DIC. She had a hypertensive crisis because it’s been at least six hours since she had her last drink. She’s detoxing.
House: The exact same moment that I’m futilely trying to give her an LP?
Foreman: Right, an invisible tumour on her pituitary is much more likely.
Chase: What if the tumour is somewhere else? There could be an ACTH-secreting tumour on her lung or pancreas.
Cameron: It’s awfully rare.
Chase: Not as rare as an invisible tumour.
House: Why didn’t they put you in charge instead of Foreman? Oh yeah, you’re the guy that killed that woman. Get a pan man scan before she dies of cortisol OD. [He makes a begging, pleading face to Foreman.]
Foreman: Fine, do it. But when you don’t find anything, put her on a Librium taper for the withdrawal and get her a bed in the rehab clinic.
It’s time for me to sign off and leave with Dr House’s most famous saying ‘everybody lies’.