Hyperhidrosis in Cushing's Disease
Hyperhidrosis (excessive sweating) is NOT a common or characteristic feature of Cushing's disease. The major clinical guidelines and consensus statements do not list hyperhidrosis among the typical manifestations of this condition.
Clinical Features Actually Associated with Cushing's Disease
The ACC/AHA hypertension guidelines and other authoritative sources consistently identify the following as the characteristic clinical features of Cushing's syndrome/disease 1:
Typical Dermatological Manifestations
- Wide (≥1 cm) violaceous (purple) striae on the abdomen 1
- Hirsutism (excessive hair growth) 1
- Facial plethora (reddish complexion) 2, 3
- Easy bruising and fragile skin 4, 2
Body Habitus Changes
- Central obesity with "moon" face 1
- Dorsal and supraclavicular fat pads (buffalo hump) 1, 4
- Rapid weight gain with central distribution 1
Musculoskeletal and Metabolic Features
- Proximal muscle weakness 1, 4
- Hyperglycemia (glucose abnormalities in >80% of patients) 1, 4
- Hypertension (present in 70-90% of cases) 4
Neuropsychiatric Manifestations
Why Hyperhidrosis Is Not Listed
The American College of Cardiology explicitly states that excessive sweating is NOT recognized as a common or characteristic clinical feature of primary Cushing's disease 4. This is a critical distinction because:
- The 2017 ACC/AHA hypertension guidelines, which provide comprehensive tables of secondary hypertension causes, do not mention sweating in the clinical indications or physical examination findings for Cushing's syndrome 1
- In contrast, these same guidelines specifically list "headache, sweating, palpitations, pallor" as characteristic features of pheochromocytoma, a different endocrine disorder 1
Clinical Pitfall to Avoid
Do not confuse Cushing's disease with pheochromocytoma. If a patient presents with episodic sweating, palpitations, and hypertensive crises, consider pheochromocytoma rather than Cushing's disease 1. The clinical presentations are distinct:
- Cushing's disease: Gradual weight gain, central obesity, striae, muscle weakness, no excessive sweating 1, 4
- Pheochromocytoma: Paroxysmal "spells" with sweating, headache, palpitations, pallor 1
Diagnostic Implications
When evaluating for Cushing's disease, focus on the established clinical features rather than sweating 4, 2. The presence of multiple characteristic findings (moon face, central obesity, wide purple striae, proximal weakness) should prompt biochemical screening with overnight dexamethasone suppression test or 24-hour urinary free cortisol 1, 2.