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Endocrinology Adrenal & Pituitary Pathology Intermediate
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Cushing Syndrome Signs: CUSHING

C
U
S
H
I
N
G
Clinical signs of hypercortisolemia resulting from exogenous glucocorticoids, pituitary adenoma, or adrenal tumors.

Excessive glucocorticoids stimulate catabolism of structural collagen, promote visceral adiposity, induce hepatic gluconeogenesis, and suppress immune responses.

Systematic Breakdown

C

Central Obesity / Moon Facies / Buffalo Hump

Dorsocervical fat pad accumulation, rounded moon face, and supraclavicular fat pad fullness.

U

Urinary Free Cortisol Elevated

Elevated 24-hour urine free cortisol or failure to suppress on low-dose dexamethasone suppression test.

S

Skin Changes (Violaceous Purple Striae)

Wide (>1 cm) purple abdominal striae, thin fragile skin, easy bruising (ecchymoses), and impaired wound healing.

H

Hypertension / Hyperglycemia / Hypokalemia

Cortisol cross-activates mineralocorticoid receptors causing sodium retention and potassium wasting.

I

Infections / Immunosuppression

Suppression of interleukin transcription, neutrophil demargination, and latent infection reactivation.

N

Neuropsychiatric / Muscle Weakness (Proximal)

Steroid psychosis, depression, insomnia, and painless proximal muscle myopathy (difficulty rising from chair).

G

Growth Retardation / Gonadal Dysfunction

Oligomenorrhea or amenorrhea in females; erectile dysfunction in males; stunted growth in children.

High-Yield Clinical Pearls & Exam Tips
  • Cushing Disease specifically refers to ACTH-secreting PITUITARY adenoma; Cushing Syndrome refers to the state of hypercortisolemia from any cause (exogenous steroids most common).
  • Screening tests: 24h urine free cortisol, late-night salivary cortisol, or 1-mg overnight dexamethasone suppression test.
Related Pharmaceuticals
Ketoconazole Metyrapone Mifepristone Pasireotide
Related Clinical Conditions
Cushing Disease Adrenal Adenoma Small Cell Lung Cancer (Ectopic ACTH)
Authoritative Sources: Endocrine Society Clinical Practice Guidelines on Cushing's Syndrome · Williams Textbook of Endocrinology

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