Cushing Syndrome: Maybe Not So Uncommon of an Endocrine Disease

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Figure 1.
Hypothalamus–pituitary–adrenal (HPA) axis differences between normal patients and patients with Cushing syndrome. A: Normal HPA axis. B: Adrenocorticotropic hormone (ACTH) dependent (Cushing disease). C: ACTH independent (Cushing syndrome). D: Ectopic ACTH syndrome. CRH, corticotropin-releasing hormone.
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Figure 2.
Flow chart of the clinical decision process used to diagnose patients suspected of Cushing syndrome (CS). UFC, urinary free cortisol; DST, dexamethasone suppression test; Dex, dexamethasone; CRH, corticotropin-releasing hormone. Copyright © 2009 Endocrine Society. Reproduced with permission.¹³

Table 1. Clinical Features of Cushing Syndrome

More Specific Signs	Common Signs	Specific Symptoms	Common Symptoms
Striae (>1 cm wide)	Acne	None	Depression
Facial plethora	Peripheral edema		Fatigue
Proximal myopathy	Muscle weakness		Weight gain
Easy bruising	Truncal obesity		Back pain
	Supraclavicular fullness		Irritability
	Dorsocervical “buffalo” hump		Decreased libido
			Menstrual abnormalities