Cushings Syndrome

Cushing's syndrome comprises the symptom complex resulting from excess circulating glucocorticoids, regardless of etiology (3). Non-adrenal causes of hypercortisolism include pituitary adenomas, ectopic corticotrophin production, and exogenous steroid use. The urologist is most often confronted with an adrenal lesion as the etiology of Cushing's syndrome.

Cushing's syndrome manifests with a variety of well recognized clinical features, including hypertension, truncal obesity, moon facies, easy bruising, and mood disorders. Diagnosis is confirmed by laboratory testing (3). Hypercortisolism is best diagnosed by 24-hour urinary cortisol measurement. The low-dose dexamethasone suppression test can be used to further diagnose Cushing's syndrome if urinary cortisol measurement is equivocal. Abdominal computed tomography scan and magnetic resonance imaging can identify adrenal adenomas or bilateral adrenal hyperplasia.

Successful surgical management of pheochromocytoma requires close collaboration among the surgeon, endocrinologist, and anesthesiologist.

It is essential to have an anesthesiologist familiar with pheochromocytoma, able to adequately manage blood pressure intra-operatively, and knowl-edgable about which anesthetic agents to avoid.

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