Cushing's syndrome

Cushing's syndrome is a favourite appearance in the medical examinations. 

Often, the stem would be to "look and proceed". Often the diagnosis would be easily suspected. 

From head to toe, the clinical findings are as below:

1. Depression or psychosis

2. Cataracts

3. Acne

4. Rounded facies

5. Hirsuitism in females

6. Central obesity

7. Increased supraclavicular fat pads

8. Increase dorso-cervical fat pad

9. Acanthosis nigricans

10. Purple striae at anterior abdomen or axillary skin folds or thighs

11. Easy skin bruising

12. Osteoporosis

13. Diabetes mellitus (look for finger prick marks at finger tips, funduscopy for diabetic retinopathy changes)

14. Hypertension (offer to check patient's blood pressure using manual sphygmomanometer)

15. Hypogonadism (menstrual disturbances, impotence)

16. Proximal muscle weakness (myopathy)

17. Thin arms and legs

Once the diagnosis of Cushing's syndrome is made, investigations will be focused on determining the aetiology of Cushing's syndrome i.e ACTH-dependent (ACTH secreting pituitary tumours/ ectopic ACTH-secreting tumours) versus ACTH-independent (adrenal causes or exogenous steroid exposure). A differential of a person with Cushingoid appearance would be pseudo-Cushing's which can be seen with persons with obesity or chronic alcoholism.

CCE.