What are the differences between Addison’s Disease vs Cushing’s?

Question

Ideally we could list Signs and Symptoms, Causes and Management.

Answer 1

These two disease states are at the opposite sides of the spectrum.

Addison's Disease is a state of adrenal insufficiency resulting in hypocorticolism.

Cushing Syndrome/Disease is a state of hypercorticolism.

They are both disease states that are related to adrenal cortex dysfunction.

Addison's Disease:

-There are two primary types of Addisons- Primary which is a manifestation of adrenal cortex damage (example causes of this damage include autoimmune, TB, metastatic disease, stress, sepsis, drug induced). The other type, secondary, is due to pituitary failure to release ACTH which leads to a decrease in cortisol production.

-Common manifestations of both types include hyperpigmentation, scant axillary and pubic hair, hypotension, weight loss.

-Lab findings: Hyperkalemia, Hypoglycemia, Hyponatremia, Low plasma cortisol <5 mcg/dL @ 0800

-Tx: Glucocorticoid and mineralocorticoid replacement; treat underlying cause.

Cushing's:

-ACTH hypersecretion by a pituitary adenoma 60-70% of cases; chronic administration of glucorticoids; nonpituitary neoplasms such as small cell carcinoma.

-Common manifestations include central obesity w/ extremity wasting, Moon face w/ buffalo hump, acne, purple striae, hirsutism, HTN, spontaneous bruising, frequent infections.

-Lab findings: Hypokalemia, Hyperglycemia, Hypernatremia, Elevated cortisol in AM. **Opposite of Addison's**

-Treatment: Remove source of excess (dc the drug, remove/tx the tumor).