Cushing's syndrome

Background

• Hypercortisolism producing an array of non-specific symptoms
• 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

• Iatrogenic
• Pituitary adenoma
• Adrenal tumor
• Adrenal hyperplasia
• Ectopic ACTH secretion

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