Cushing syndrome and hypercorticism
• Cushing syndrome (CS) is characterized by truncal
obesity, moon face, abdominal striae, hypertension, decreased carbohydrate
tolerance, protein catabolism, psychiatric disturbances, and amenorrhea and
hirsutism in females. It is associated with excess adrenocorticosteroids of
endogenous or exogenous source.
• Cushing disease refers to CS associated with pituitary
adrenocorticotropic hormone (ACTI-l)- producing adenoma.
• CS medicamentosum refers to CS caused by exogenous
administration of glucocorticoids.
Skin lesions
1. A
plethoric obese person with a classic habitus that results from the redistribution
of fat: moon facies, buffalo" hump, truncal obesity, and thin arms and
legs.
2. Purple
striae, mostly on the abdomen and trunk; atrophic skin with easy bruising and
telangiectasia.
3. Facial
hypertrichosis with pigmented hairs and often increased lanugo hairs on the
face and arms.
4. Androgenetlc
alopecia in females.
5. Acne
of recent onset (without comedones) or flaring of existing acne.
General symptoms
Fatigue and muscle weakness, hypertension, personality
changes, amenorrhea in females, polyuria, and polydipsia.
Workup
1. Determination
of blood glucose, serum potassium, and free cortisol in 24-h urine.
2. Abnormal
dexamethasone suppression test with failure to suppress endogenous cortisol
secretion when dexamethasone is administered.
3. Elevated
ACTH.
4. CT
scan of the abdomen and the pituitary.
5. Assessment
of osteoporosis.
Management
Elimination of exogenous glucocorticoids or the detection
and correction of underlying endogenous cause.
