Cushing's Syndrome and Peripheral Circulation
Cushing's syndrome does not directly cause poor circulation to the hands and feet as a characteristic feature of the disease. The available medical literature does not identify peripheral vascular insufficiency or poor circulation to extremities as a recognized manifestation of hypercortisolism.
Primary Cardiovascular Manifestations
The cardiovascular complications of Cushing's syndrome are well-characterized but focus on different pathophysiology:
Hypertension is the dominant cardiovascular feature, occurring in 70-90% of patients with Cushing's syndrome, primarily through mineralocorticoid receptor activation by excess cortisol, which increases renal sodium absorption 1, 2.
Premature atherosclerosis and coronary artery disease develop from the metabolic derangements, including metabolic syndrome, obesity, glucose intolerance, insulin resistance, dyslipidemia, and endothelial dysfunction 3, 4.
Increased cardiovascular mortality results from myocardial infarction, cardiac failure, stroke, and pulmonary emboli—not from peripheral vascular insufficiency 5, 4.
Recognized Clinical Features
The constellation of symptoms in Cushing's syndrome includes 1, 6:
- Weight gain with central obesity
- Abdominal striae and fragile skin
- Muscle weakness
- Mood disorders and menstrual irregularities
- Glucose abnormalities exceeding 80% prevalence
- Severe hypertension
Notably absent from this comprehensive list is any mention of poor peripheral circulation, Raynaud's phenomenon, or vascular insufficiency to the extremities.
Important Clinical Caveat
While Cushing's syndrome causes severe multisystem morbidity and increases cardiovascular risk through multiple mechanisms—including activation of the renin-angiotensin system, sensitization of vasculature to catecholamines, and impairment of nitric oxide bioavailability 1, 2—these pathways manifest as hypertension, atherosclerosis, and thrombotic complications rather than poor peripheral circulation.
If a patient presents with both Cushing's syndrome and poor circulation to hands and feet, these are likely separate conditions requiring independent evaluation. The poor circulation would warrant investigation for other causes such as peripheral arterial disease, Raynaud's phenomenon, or other vasculopathies unrelated to the hypercortisolism 3.