@AnKing-Maintainers
This card is directly quoting Sketchy and I believe is misleading to suggest only Cushing syndrome from pituitary adenomas cause hyperpigmentation
I support this change but I have a question about the location of the hyperpigmentation
If i remember correctly amboss says that it happens in the area that is not exposed to sun
Yanno, I completely ignored glossed over that part, but you’re right. I can’t find anywhere on AMBOSS about sun or trauma exposed areas. Again this card comes from sketchy.
There’s this card too [05.21.2024] Updated content, AnKing Overhaul for Step 1 & 2/AnKingMed, ID 1606671
I might change my suggest for that other note to edit the text as well because that says Cushing disease specifically. I need to check about the POMC part because i’m not sure if ectopic ACTH will have high levels of POMC leading too all subtypes of MSH or just alpha-MSH
AMBOSS
If secondary hypercortisolism: often hyperpigmentation (darkening of the skin due to an overproduction of melanin), especially in areas that are not normally exposed to the sun (e.g., palm creases, oral cavity)
- Caused by excessive ACTH production because melanocyte-stimulating hormone (MSH) is cleaved from the same precursor as ACTH called proopiomelanocortin (POMC)
- Not a feature of primary hypercortisolism
Seems conflicting and not sure what to do about the actual cloze. Either way I think we need to change the part suggesting hyperpigmentation is in Cushing disease specifically.
I can’t find sources, but here’s my best guess at this.
When the hyperpigmentation is extreme it is most evident in areas that would be highly pigmented to begin with e.g., sun exposed.
When the hyperpigmentation is not apparent, checking areas that are not usually pigmented will be more obvious e.g., oral mucosa.
Either way that would be a different suggestion because this suggestion is about fixing Cushing syndrome from pituitary adenoma as only cause of hyperpigmentation.