From the Guidelines
Cushing's syndrome is characterized by ten key signs and symptoms, including central obesity, thin fragile skin, purple-red stretch marks, muscle weakness, mood changes, metabolic disturbances, hirsutism, irregular menstrual periods, poor wound healing, and persistent fatigue, as a result of excessive cortisol exposure 1.
Key Signs and Symptoms
The signs and symptoms of Cushing's syndrome can be summarized as follows:
- Central obesity with a characteristic "buffalo hump" on the upper back and a rounded "moon face"
- Thin, fragile skin that bruises easily
- Purple-red stretch marks (striae) on the abdomen, thighs, and breasts
- Muscle weakness, particularly in the limbs
- Mood changes including depression, irritability, and anxiety
- Metabolic disturbances manifesting as high blood pressure, elevated blood sugar, and decreased bone density
- Hirsutism and irregular menstrual periods in women
- Decreased libido and erectile dysfunction in men
- Poor wound healing and increased susceptibility to infections
- Persistent fatigue These symptoms develop gradually as cortisol levels rise, whether from excessive pituitary ACTH production, adrenal tumors, or long-term glucocorticoid medication use 1.
Clinical Presentation
The clinical presentation of Cushing's syndrome can vary depending on the underlying cause, but most patients present with a combination of these signs and symptoms. It is essential to recognize these symptoms early to initiate prompt treatment and prevent long-term complications, such as cardiovascular disease, diabetes, and osteoporosis 1.
Diagnosis and Treatment
Diagnosis of Cushing's syndrome involves a combination of clinical evaluation, laboratory tests, and imaging studies. Treatment depends on the underlying cause and may involve surgical removal of the tumor, medical management with adrenostatic agents, or bilateral adrenalectomy 1.
From the Research
Signs and Symptoms of Cushing's Syndrome
The following are 10 signs and symptoms of Cushing's syndrome:
- Weight gain, particularly in the face, back of the neck, and visceral organs 2
- Hyperglycemia, or high blood sugar 2, 3
- Hypertension, or high blood pressure 2, 3
- Easy bruising 2
- Purple striae, or stretch marks 2, 3
- Facial plethora, or a reddened face 2
- Proximal muscle weakness 3
- Neurocognitive changes, such as mood disorders and psychiatric and cognitive deficits 2, 3, 4
- Immunosuppression, making patients more susceptible to infections 2, 4
- Cardiovascular disease, including an increased risk of myocardial infarction and cerebrovascular accidents 4
Biochemical Screening
Biochemical screening for Cushing's syndrome may include:
- 24-hour urinary free cortisol test 2, 4
- Late-night salivary cortisol test 2, 4
- 1 mg dexamethasone suppression test 3, 4 These tests can help diagnose Cushing's syndrome and distinguish it from other conditions. However, each test has its own caveats, and the choice of tests should be individualized based on each patient's characteristics and lifestyle 3.