Patient: [Patient Name]
Date: [Date of Encounter]
I. Chief Complaint (consider incorporating multiple if present):
Central obesity (weight gain, fat around the abdomen, “buffalo hump”)
Easy bruising
Proximal muscle weakness
Skin striae (purple stretch marks)
Easy fatigability
Mood swings, depression, anxiety
Hirsutism (excessive facial and body hair in females) – females only
II. History of Present Illness:
Onset and duration of symptoms
Progression of symptoms (worsening, improvement)
Use of medications that can cause Cushing’s syndrome (corticosteroids)
Past medical history suggestive of Cushing’s syndrome (adrenal tumors, pituitary tumors)
III. Past Medical History:
Underlying medical conditions (diabetes, hypertension)
Psychiatric history (depression, anxiety)
IV. Medications:
Current medications (including corticosteroids, medications for other medical conditions)
V. Social History:
Smoking history (can worsen some Cushing’s symptoms)
VI. Family History:
Family history of Cushing’s syndrome (rare)
VII. Physical Exam:
Vital signs (BP may be elevated)
General appearance (central obesity, moon facies – rounded face, facial plethora – reddish flushing)
Skin exam (bruising, striae)
Muscle strength testing (proximal muscle weakness)
VIII. Laboratory Studies:
Serum cortisol level (may be elevated)
Late-night salivary cortisol (often elevated in Cushing’s)
Urine free cortisol (may be elevated)
ACTH (adrenocorticotropic hormone) level – may be high (Cushing’s disease) or low (secondary or ectopic Cushing’s)
Other tests (blood sugar, electrolytes) – may be abnormal depending on the severity of Cushing’s
IX. Imaging Studies (consider as appropriate):
High-resolution CT scan of the adrenal glands – to identify adrenal tumors
Pituitary MRI scan – to identify pituitary tumors (Cushing’s disease)
Other imaging studies (chest X-ray, PET scan) – may be used in specific cases
X. Assessment:
Suspected or confirmed Cushing’s syndrome based on clinical presentation, laboratory tests, and imaging studies (if available).
Cushing’s subtype (Cushing’s disease – pituitary ACTH-secreting tumor, ectopic ACTH syndrome – ACTH production from non-pituitary tumors, secondary Cushing’s – caused by exogenous corticosteroids) – further testing needed to differentiate.
Severity of Cushing’s syndrome and its impact on overall health.
XI. Plan:
Treatment depends on the type and severity of Cushing’s syndrome:
Cushing’s disease: Surgery (transsphenoidal surgery) to remove the pituitary tumor is the preferred treatment. Radiation therapy or medications may be used if surgery is not feasible.
Ectopic ACTH syndrome: Treatment of the underlying tumor causing ACTH production.
Secondary Cushing’s syndrome: Reduce or discontinue the offending medication if possible.
Management of comorbidities (diabetes, hypertension)
Monitoring of cortisol levels and clinical symptoms to assess treatment response.
XII. Prognosis:
Discuss the potential for improvement with treatment and the importance of ongoing management to control Cushing’s syndrome and its complications.
Address the patient’s anxieties and concerns related to the diagnosis and treatment.
XIII. Notes:
Include any additional observations or concerns, such as patient’s understanding of the diagnosis and treatment plan, potential side effects of medications or surgery, need for emotional support, and referral to an endocrinologist for further management.
XIV. Resources:
Consider providing patient education materials on Cushing’s syndrome from reputable sources (e.g., Cushing’s Syndrome Foundation, National Institute of Diabetes and Digestive and Kidney Diseases).