Preoperative abnormalities

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1. A review of 31 patients with Cushing's disease showed that the commonest clinical features, in order of frequency, were: weakness, thin skin, obesity, easy bruising, hypertension, menstrual disorders, hirsutism, impotence, striae, proximal muscle weakness, oedema, osteoporosis, mental disorders, diabetic GTT, backache, acne, hypokalaemia and fasting hyperglycaemia (Urbanic & George 1981). Fractures occur, and wound healing is poor.

2. Biochemical abnormalities include hypokalaemic alkalosis, sodium and water retention, hyperglycaemia, lack of diurnal variation in plasma cortisol with failure to decrease at night, and increased urinary free cortisol.

3. Cushing's syndrome is associated with severe left ventricular hypertrophy, with disproportionate hypertrophy of the interventricular septum (Sugihara et al 1992). The cause is unknown.

4. Patients have an increased incidence of infections.

5. Screening by overnight dexamethasone test and 24-h urinary excretion of cortisol (Klibanski & Zervas 1991).

6. Occasionally patients become pregnant, in which case the commonest complications are hypertension and diabetes (Aron et al 1990, Prihoda & Davis 1991).A patient with Cushing's syndrome and a phaeochromocytoma underwent laparoscopic adrenalectomy at 17 weeks' gestation (Finkenstedt et al 1999).

7. Cushing's disease is more difficult to diagnose during pregnancy because of gestational changes in the HPA axis.

8. Patients with treated Cushing's disease who are considered 'cured' still have an increased risk of cardiovascular disease and atherosclerosis, despite having normal cortisol levels (Colao et al 1999).

9. Treatment of Cushing's syndrome may unmask other diseases.A patient treated with adrenalectomy developed sarcoidosis 6 weeks later (Walmsley & Bevan 1995).

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Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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