Cushing's syndrome

Background

  • Hypercortisolism producing an array of non-specific symptoms
  • Exclude exogenous glucocorticoids and pregnancy

Clinical Features

  • Cutaneous: easy bruising, friable, striae, hyperpigmentation
  • Endocrine
  • Metabolic: progressive obesity (esp. buffalo hump and supraclavicular fat pads obscuring clavicles)
  • Muscle: proximal muscle atrophy, weakness
  • 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

UpToDate