Cushing's syndrome

(Redirected from Cushing’s syndrome)

Background

  • Hypercortisolism producing an array of non-specific symptoms[1]
  • Exclude exogenous glucocorticoids and pregnancy
  • Called "Cushing disease" if caused by pituitary tumor

Clinical Features

  • Cardiovascular: Hypertension
  • Cutaneous: easy bruising, friable, striae, hyperpigmentation, poor wound healing
  • Endocrine
    • Androgen excess causing hirsutism, amenorrhea, oily skin, increased libido
    • Glucose intolerance
    • Obesity
  • Metabolic: progressive obesity (esp. buffalo hump and supraclavicular fat pads obscuring clavicles)
  • Musculoskeletal: proximal muscle atrophy, weakness, osteoporosis
  • Ophthalmologic: cataracts, increased intraocular pressure
  • Psychologic: emotional lability, depression, irritability, anxiety, panic attacks, mild paranoia and mania

Differential Diagnosis

Evaluation

  • Outpatient: 24h urinary free cortisol or dexamethasone suppression test

Management

  • Treat complications (e.g. hyperglycemia) as appropriate
  • Typically outpatient/non-ED management

Disposition

  • Typically discharge

References

  1. Nieman LK. Causes and pathophysiology of Cushing’s syndrome. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc.