Is it common to see Cushing\'s disease associated with acromegaly? What is the d

Question

Is it common to see Cushing's disease associated with acromegaly? What is the difference between Cushing's disease and Cushing's syndrome? What is Addison's disease?

Personal Information

Name: Mr. Elliot Bryan

Age: 29 years old

Gender: Male

Description

Mr. Bryan is a 29-year-old married man who came to the medical office because, over the last three years, he has progressively increased the size of his shoes, and he has resized his wedding ring three times. He says his feet and hands have grown. He has also noticed that his face has turned coarse. He was a very active man and practiced sports, but now he fatigues just by walking, and feels weakness in his muscles and stiffness in his joints. He is depressed because in the last few months he has been experiencing erectile dysfunction, which is affecting his relationship with his wife. He feels he is losing his vision as well.

Mr. Bryan does not drink alcohol, smoke, or use any recreational drug. His mother suffers from diabetes mellitus type II, and his father suffers from hypertension.

On physical examination we found:

Remarkable Signs on Physical Exam by Regions

Head: Enlarged and coarsened facial features, prominent superciliary arches, prognathism

Neck: Thyroid is visible and palpable

Thorax: Barrel appearance

Abdomen: Hepatomegaly. Splenomegaly.

SOMA: Enlargement of the hands and feet. Generalized arthralgia.

Remarkable Signs on Physical Exam by Systems

Integumentary system: Thick and oily skin. Numerous acrochorda disseminated throughout the body.

Cardiovascular system: Blood pressure 150/100. Radial pulse 72.

Digestive system: Megaloglossia. Diastema.

Lab Tests

Complete blood count (CBC)

GH measurement

IGF-I measurement

Growth hormone suppression test

Glucose level

Brain MRI

Abdominal CT scan

Echocardiogram

Diagnosis

Acromegaly

Explanation / Answer

1.Yes, it is common to see cushing disease with acromegaly because both originates from the same gland but depends on the hormone which is released.Pituitary gland over produces the hormones and causes these disease.This over production might be due to idiopathic reasons ,some injures to head ,presence of tumor.All will lead to overproduction of the different hormones released by pituitary gland. When there is increased release of growth hormones it leads to acromegaly and when there is increased production of ACTH which lead to increase cortisol level causes Cushing disease.

2.Cushing disease and Cushing syndrome are both the conditions when the body produces too much cortisol ,but both disease are different. In Cushing syndrome there is increase production of cortisol in the body due to many reasons like intake of corticosteroid medications etc.

In Cushing disease there is overproduction of cortisol due to tumor of pituitary gland which leads to increase in ACTH and ACTH causes adrenal glands to produce high levels of cortisol.

3. Addison's disease is due to insufficient production of cortisol by the adrenal cortex.Causes are:-

Idiopathic atrophy of adrenal glands

Surgical removal of both adrenal glands

Infection

TB of adrenal gland

Insufficient release of Adrenocorticotropic hormones.

Cessation of taking corticosteroid medicines.

Clinical manifestation are:-

Anorexia, muscle weakness,fatigue,dark pigmentation of skin and mucous membrane, hypotension, hypoglycemia, hyponatremia,and hyperkalemia.

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