What are the typical exam findings that indicate Cushing's (Cushing's) syndrome?

Key Physical Examination Findings in Cushing's Syndrome

The most characteristic physical examination findings that indicate Cushing's syndrome include central obesity, "moon" face, dorsal and supraclavicular fat pads, wide (>1 cm) violaceous striae, hirsutism, and proximal muscle weakness. 1

Cardinal Physical Examination Findings

Body Composition and Fat Distribution

• Central obesity with abnormal fat distribution, particularly in the supraclavicular and temporal fossae 1
• "Moon face" (facial plethora and rounded facial appearance) 1
• Buffalo hump (dorsocervical fat pad) 1
• Supraclavicular fat accumulation 1
• Thin extremities with central adiposity 2

Skin Changes

• Wide (>1 cm) purple/violaceous striae, especially on the abdomen 1
• Facial plethora (reddish-purple facial appearance) 1, 2
• Thinned, fragile skin that bruises easily (ecchymoses) 1, 3
• Poor wound healing 4
• Acne 1

Musculoskeletal Findings

• Proximal muscle weakness or wasting (especially in the lower limbs) 1
• Osteoporosis (may present as pathological fractures) 5

Hirsutism and Hair Changes

• Hirsutism (excessive hair growth in women in male-pattern distribution) 1
• Vellous hypertrichosis (fine hair growth) 4

Additional Physical Findings

Cardiovascular Signs

• Hypertension 1
• Fluid retention 1
• Arrhythmias (especially with hypokalemia) 1

Reproductive Changes

• Menstrual irregularities in females 1
• Impotence in males 5

Clinical Pitfalls and Considerations

• The prevalence of Cushing's syndrome is low (<0.1% of the general population), but it should be considered in patients with unexplained hypertension and metabolic abnormalities 1
• Physical findings may overlap with those of metabolic syndrome or simple obesity, but the presence of proximal muscle weakness, wide purple striae, and facial plethora are more specific for Cushing's syndrome 1, 2
• In children, a key distinguishing feature is decreased linear growth with continued weight gain 3
• The combination of central obesity, "moon face," dorsocervical fat pad, and wide purple striae has high specificity for Cushing's syndrome 1, 2
• Physical findings may vary in severity depending on the duration and degree of cortisol excess 2, 3

Remember that while these physical examination findings are suggestive of Cushing's syndrome, biochemical confirmation is required through appropriate laboratory testing such as 24-hour urinary free cortisol, overnight dexamethasone suppression test, or midnight salivary cortisol 1, 2, 4.