From the Guidelines
Moon facies is a medical condition characterized by a rounded, puffy appearance of the face, most commonly associated with Cushing's syndrome, which requires prompt medical evaluation to prevent serious complications such as diabetes, hypertension, and osteoporosis. This condition occurs due to excessive cortisol levels in the body, leading to redistribution of fat to the face, neck, and trunk, as well as fluid retention. Patients with moon facies often experience other symptoms, including:
- Weight gain, particularly in the abdomen, chest, and face
- Thin skin that bruises easily
- Purple stretch marks
- Muscle weakness
- Mood changes
The underlying causes of elevated cortisol can include:
- Prolonged use of corticosteroid medications (like prednisone)
- Adrenal or pituitary tumors
- Rarely, ectopic ACTH-producing tumors
Treatment focuses on addressing the underlying cause, which may involve:
- Gradually tapering corticosteroid medications under medical supervision
- Surgical removal of tumors
- Medications to reduce cortisol production, as recommended by the most recent guidelines, such as those outlined in the consensus guideline for the diagnosis and management of pituitary adenomas in childhood and adolescence 1
According to the most recent and highest quality study, selective adenomectomy is recommended as the first-line treatment of choice for Cushing's disease 1. Additionally, the study highlights the importance of lifelong follow-up for children treated for Cushing's disease, as recurrence can occur even after apparent surgical cure 1.
It is essential to note that untreated Cushing's syndrome can lead to serious complications, including diabetes, hypertension, and osteoporosis, as discussed in the consensus on diagnosis and management of Cushing's disease 1. Therefore, prompt medical evaluation and treatment are crucial to improve morbidity, mortality, and quality of life outcomes.
From the Research
Moon Facies and Cushing's Syndrome
- Moon facies, also known as moon face, is a common symptom of Cushing's syndrome, a hormonal disorder caused by prolonged exposure to high levels of cortisol 2, 3, 4, 5, 6.
- Cushing's syndrome can be caused by a variety of factors, including pituitary adenomas, ectopic ACTH production, and adrenal neoplasias 2, 3, 4, 5, 6.
Treatment of Cushing's Syndrome
- The primary treatment for Cushing's syndrome is surgical removal of the tumor causing the excess cortisol production 2, 3, 4.
- However, in some cases, medical therapy may be necessary to control hypercortisolism, especially when surgery is unsuccessful or contraindicated 2, 3, 4, 5, 6.
- Adrenal-blocking agents, such as ketoconazole and metyrapone, can be used to suppress adrenal cortisol production 2, 3, 4, 5, 6.
Medical Therapies for Cushing's Syndrome
- Ketoconazole is a commonly used medication for the treatment of Cushing's syndrome, and it works by inhibiting adrenal 11 beta-hydroxylase and 17,20-lyase 5, 6.
- Etomidate is another medication that can be used to treat Cushing's syndrome, and it works by inhibiting 11 beta-hydroxylase 3, 5.
- Other medications, such as metyrapone, osilodrostat, and mitotane, can also be used to treat Cushing's syndrome 3, 4.