Symptoms of Cushing's Different depending on cause?

[sharklasers]

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I guess this doesn't refer to the main symptoms of Cushing's, like truncal obesity, diabetes, etc.

ACTH would cause hyperpigmentation via MSH formation from POMC and it would cause hirsutism by stimulating the zona reticularis and increased andgrogen levels.

So would some Cushing's caused by a pituitary adenoma have the above effects but Cushing's caused by an adrenal adenoma not?

Also, is the amenorrhea and osteoporosis due to negative feedback on GnRH or is it somehow due to increased androgens messing up the estrogen:androgen ratio or something (i'm assuming the former)

Thanks!

 

[Jamiu22]

I guess this doesn't refer to the main symptoms of Cushing's, like truncal obesity, diabetes, etc.

ACTH would cause hyperpigmentation via MSH formation from POMC and it would cause hirsutism by stimulating the zona reticularis and increased andgrogen levels.

So would some Cushing's caused by a pituitary adenoma have the above effects but Cushing's caused by an adrenal adenoma not?

Also, is the amenorrhea and osteoporosis due to negative feedback on GnRH or is it somehow due to increased androgens messing up the estrogen:androgen ratio or something (i'm assuming the former)

Thanks!

Yes, you are right, Pituitary Cushings would present with hyperpigmentation via MSH, while that of an adrenal adenoma would not (here ACTH production would be low due to the negative feedback of cortisol on the pituitary; so POMC will be less not active.. thus MSH would also be low - no hyperpig...).

On the other hand, additional symptoms like excess androgens would always been seen with excess ACTH, but it may or may not be seen in patients with adrenal adenoma - it just depends on how invasive the adenoma is and whether it's causing disregulation of the zona reticularis (ZR) layer. If its infiltrating the zona reticularis, it will most likely affect it's functioning in a negative way, so you would get less androgens (but cancer cells do not always follow the appropriate rules, so it may stimulate the ZR - but highly unlikely).

 

[CaptainSSO]

I guess this doesn't refer to the main symptoms of Cushing's, like truncal obesity, diabetes, etc.

ACTH would cause hyperpigmentation via MSH formation from POMC and it would cause hirsutism by stimulating the zona reticularis and increased andgrogen levels.

So would some Cushing's caused by a pituitary adenoma have the above effects but Cushing's caused by an adrenal adenoma not?

Also, is the amenorrhea and osteoporosis due to negative feedback on GnRH or is it somehow due to increased androgens messing up the estrogen:androgen ratio or something (i'm assuming the former)

Thanks!

I THINK (could be totally wrong) that the osteoporosis is at least partially due to up-regulation of RANK-L by cortisol. No idea about the amenorrhea mechanism.