USMLE ALGORITHMS: Cushing Syndrome

This video explains the complete workup of Cushing Syndrome, the causes, the diagnosis, and the full management. It is very thorough. I hope you enjoy

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[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.

[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

[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.

[thewizardofdark1]

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

[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...

[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?

[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.

[whisperingsage]

Of Course, the treatment is ALWAYS surgery!

[janinelovesmusic]

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