Now, when it comes to Cushing, it's a weird name, but not really
because Harvey is the one who discovered the disease.
Now, the disease and the syndrome, what's the relationship, or what's the difference?
Well, they look the same. The clinical symptoms look the same.
But the cause of Cushing's disease and syndrome is different.
Cushing disease is something has gone out of control in your body, right?
Somewhere along in that process that we talked about, from your brain, your pituitary,
your adrenal glands, something is out of control; one of those pieces has gone rogue.
But in Cushing syndrome, we've done this to the patient by giving them corticosteroids.
We have inflated the amount, increased the amount of corticosteroids they have in their body
because we gave them medication; likely because we wanted to suppress inflammation.
But either way they have these higher levels of corticosteroids now than normal,
and everything kind of gets suppressed; but it's the same clinical symptoms.
So, whether you have Cushing's disease or Cushing syndrome,
clinically, the symptoms are gonna look the same but the cause is different.
Now, which one do you think you'll see more of in your career?
Yeah, hands down, Cushing's syndrome.
You may see some Cushing's disease patients,
but really, what you're gonna see, because of the volume of corticosteroids we get,
you're gonna see Cushing syndrome far more often than Cushing's disease.
Now, Cushing's, by any name, is caused by excess ACTH.
That's why you end up with lots of ACTH, and you end up with lots of the extra corticosteroids.
Now, the two types, we introduced you to this, but we're gonna break it down a little bit more.
You've got aldosterone and you've got cortisol.
Now, aldosterone, is a mineralocorticoid. How can you remember that?
Remember what its job is, its job is to tell you to hang on to sodium.
Think of that as a mineral. So, that makes sense.
It'll control the electrolytes and water levels in your body.
Hang on to sodium, what happens to potassium?
Yeah, you're gonna get rid of it.
So, if my sodium's going up, my potassium is usually going down.
Because it promotes sodium retention by the kidneys,
you're gonna see that impact on the other electrolyte of potassium.
So, that's aldosterone. Now, the other type that comes from the cortex, cortisol.
That's got the carb, fat, and protein metabolism. It's an anti-inflammatory.
And so, you wanna think through,
do I recognize all of the impacts of mineralocorticoids and glucocorticoids?
We've hit it a couple times in this presentation
because it's critical that you have that ground work laid.
Now, don't panic, this is not something you have to memorize.
The key point is that left side of the column.
See it there, starts with hydrocortisone at the top, dexamethasone at the bottom.
But in between, familiarize yourself with those names if you're not currently familiar with them.
What's the same between all of those names?
They end in S-O-N-E or L-O-N-E. Cool.
That's a shortcut tip for you to recognize a drug name that it's a corticosteroid.
Now, looking at the top one, you see:
glucocorticoid potency and mineralocorticoid, it's one to one. There you go.
But go all the way to the bottom at dexamethasone.
You'll see that the mineralocorticoid potency is zero.
Now, in between, it's varying ranges. But you see that it's zero.
That means if a patient is taking dexamethasone,
we're not gonna anticipate a lot of sodium retention, dropping off of potassium,
food volume changes, et cetera.
Because we don't have a strong mineralocorticoid potency.
With hydrocortisone, you would see that impact.
So, again, a list of some and I underscore, some of the things we use corticosteroids to treat.
We give it for lots and lots of things.
But we have an undesired effect of drug induced Cushing syndrome.
So, keeping in mind, when the patient has Cushing's disease or Cushing's syndrome,
they're gonna have the same type of clinical symptoms.