Symptoms of Cushing's Syndrome
Cushing's syndrome presents with rapid weight gain with central distribution, proximal muscle weakness, depression, and hyperglycemia as its primary clinical manifestations. 1
Clinical Manifestations
Physical Appearance Changes
- Central obesity - particularly in face, neck, and trunk
- "Moon face" - round, full facial appearance
- Dorsal and supraclavicular fat pads ("buffalo hump")
- Wide (1-cm) violaceous striae - particularly on abdomen, breasts, and thighs
- Facial plethora - reddish-purple facial flushing
- Hirsutism - excessive hair growth, particularly in women
Metabolic Disturbances
- Hyperglycemia - often leading to diabetes or glucose intolerance
- Hypertension - often resistant to standard treatments
- Dyslipidemia - elevated cholesterol and triglycerides
Musculoskeletal Issues
- Proximal muscle weakness - difficulty rising from chairs or climbing stairs
- Muscle atrophy - particularly in the extremities
- Osteopenia/osteoporosis - leading to increased fracture risk
- Delayed wound healing
Dermatologic Findings
- Skin thinning and atrophy
- Easy bruising - even with minimal trauma
- Poor wound healing
- Acne
Neuropsychiatric Symptoms
- Depression
- Anxiety
- Sleep disturbances
- Cognitive impairment
- Mood disorders
Reproductive Issues
- Menstrual irregularities in women
- Decreased libido
- Erectile dysfunction in men
- Infertility
Diagnostic Approach
When Cushing's syndrome is suspected based on the above symptoms, screening tests include:
- Overnight 1-mg dexamethasone suppression test - preferred initial screening test 1, 2
- 24-hour urinary free cortisol excretion (preferably multiple samples) 1, 3
- Late-night salivary cortisol - particularly useful for outpatient screening 3, 4
Clinical Significance
Cushing's syndrome is associated with significant morbidity and mortality, primarily due to:
- Cardiovascular complications from hypertension
- Metabolic derangements including diabetes
- Immunosuppression leading to increased infection risk
- Psychiatric disorders affecting quality of life
- Bone loss leading to fractures
Important Considerations
- The prevalence of Cushing's syndrome is relatively low (<0.1% of hypertensive patients) 1
- Many symptoms overlap with common conditions like metabolic syndrome, making diagnosis challenging
- The constellation of symptoms is more specific than any individual symptom
- Patients with incidentally discovered adrenal masses should be screened for cortisol excess 1
- Exogenous glucocorticoid use is the most common cause of Cushing's syndrome and should be ruled out first 3, 4
Early recognition of this symptom complex is critical as untreated Cushing's syndrome significantly increases cardiovascular risk and mortality beyond that of essential hypertension 2.