USMLE ALGORITHMS: Cushing Syndrome

[thewizardofdark1]

pardon me for posting same comment multiple times cause i'm not used to with utube system...

[thewizardofdark1]

making a flow chart after copying the vdo is not tough. well tell me where to send it if u want me to make one for u...

thanks for at least making & sharing the vdo. best of luck...

[thewizardofdark1]

where to search for the flow chart? is there any flow chart in a page or we've to write it down for ourselves?

[thewizardofdark1]

well, copying that diagram is not tough. if u guys could tell me where to find that then it will save some time. if not i can make it for myself & i can post it to anywhere u ppl suggest...

[whisperingsage]

Of Course, the treatment is ALWAYS surgery!

[janinelovesmusic]

i already deleted my posted message 5 days ago. I hope that is enough. 

[mary2win]

My deceased mother had Cushing's. And I have Acromegaly. I wonder could the two diseases be related?

[aberkovits]

Thanks for the video. Is this algorithm up to date for the 2010 boards?

[AtPGaming]

Very good video dude. Got so many endocrine disorders to revise!

[vivalaleta]

Terrible acne beginning at the age of 42, quick weight gain, deep ongoing depression and anxiety - I think I need to take this test.

[kamsharafi]

thanks so much... you are great.

[happyrnstudent]

Thanks for walking us through that!

[acetylecholine]

thank you very much .. :)

[atomictromette]

I don't see anything there about the cortisol salivary test?

[josephmedman]

I've had a lot of controversy on this particular upload. I actually went to my videos main page and specifically stated that these videos are meant to be used for USMLE only. I'm sorry but for the United States Medical Licensing Exam we are not required to know about the Cortisol salivary test which is why I did not include it because it will only confuse students.

[Taniaxx]

Excellent, thanks for uploading :)

[josephmedman]

I understand your concern, however if you recall this was your comment to me "Thanks for perpetuating that lack of or bad care. " I'm sorry, but I felt like a rude comment like that needed to be deleted. I am not an endocrinologist, nor an expert in the field, however I am an expert in USMLE preparation, and exams and anything other than this algorithm would get my students the answer wrong on the exam.Many things that work practically, are not the answers US boards are looking for..

[sowens0074]

Ok, so it isn't you. Sorry for the confusion. We knew doctor's had a hard time with Cushing's. Now we know where some of the problem is, or at least I am enlightened. Good to know for future articles.

[josephmedman]

thanks for understanding..I really am just presenting the information how the Medical Boards requires us to know it. I am quite sure you know a lot more than me on this topic which is why I left Cushiewomans comment above as you can see. It's educational to know this, and I'm glad you brought up the point. Thanks for the input..

[sowens0074]

If you only knew what hoops we have to jump threw to get help, you would understand our frustration. Many of us have seen this dreaded chart. Many of us have lost everything we own trying to pay for help out of town at the few specialists there are for diagnosing Cushing's. I am bitter, but I apologize for sounding so in my post. Thanks for understanding.

[cowbellshell]

Encourage doctors to think about things---and

CAREFULLY READ the labs they order.

My dex test came back normal---but it wasn't. Doctor didn't realize that my baseline cortisol test at 8am was below where it should have been. It was flagged---but ignored.

[Cushiewoman]

"Gold Standard" doesn't always work. I'm a Cyclical Cushing's patient. Never had high 24 hr. UFC, got high midnight serums and high 17-OHCS. IPSS post CRH was ratio of 37:1. Negative results do not outweigh positives, even if the amount of positives outnumber lows. Just means the patient is cyclical. I cycle on and off all through the day, making my UFC's average out to a normal number. That's why the 17-OHCS is such an important test for patients like me.

[TiredOldFart]

@Cushiewoman The gold standard is useless. Only careful work by a qualified doctor will bring this disease to diagnosis. Too many doctors depend on a solitary test and then reject the diagnosis when that tests comes out marginally positive. Since when is "it's rare" a branch in the differential diagnosis? I'm horrified to learn from the remarks above that the midnight cortisol and ACTH test isn't required learning for this exam. That means pass without understanding the HPA loop at all.

[myrelaxingvids]

i love the videos btw! very helpful! :)

[myrelaxingvids]

after the high dose test, and given that there was no suppression, why would the levels of ACTH be low?

[josephmedman]

The output of an ectopic source will not suppress with with high dose dexamethasone. If ACTH levels are low, etiology is most prob. from an adrenal tumor such as adenoma, cancer or adrenal hyperplasia.When the adrenal gland is the source of increased cortisol, there is feedback inhibition ont he pituitary and the ACTH levels is suppressed. Hope it makes sense to you