Symptoms of Cushings Syndrome
Excessive cortisol is highly unlikely. Although the listed findings are consistent with glucocorticoid excess, they are nonspecific; most patients with such findings do not have Cushing’s syndrome. True Cushing’s syndrome is uncommon, with an incidence of two to three cases per million people per year, although it may be higher in patients with hypertension, diabetes, osteoporosis, or incidental adrenal masses.
| MORE SPECIFIC, LESS COMMON | MORE COMMON, LESS SPECIFIC |
|---|---|
| Easy bruising, thin skin (in young patient) | Hypertension |
| Facial plethora | Obesity/Weight gain |
| Violaceous striae | Abnormal glucose tolerance or diabetes mellitus |
| Proximal muscle weakness | Depression, irritability |
| Hypokalemia | Peripheral edema |
| Osteoporosis (in young patient) | Acne, hirsutism |
| Decreased libido, menstrual irregularities |
Hirsutism is a common, nonspecific finding in many female patients. However, it is also consistent with Cushing’s syndrome. If it is caused by Cushing’s syndrome, hirsutism results from excessive production of adrenal androgens under ACTH stimulation. Thus, hirsutism in a patient with Cushing’s syndrome is a clue that the disorder is caused by excessive production of ACTH. (The only other condition associated with excessive production of glucocorticoids and androgens is adrenal cancer, which is usually obvious on presentation.)
Hyperpigmentation is a sign of elevated production of ACTH and related peptides by the pituitary gland. It is uncommon (but possible) in Cushing’s syndrome caused by benign pituitary tumors because levels of ACTH do not usually rise high enough to cause hyperpigmentation. It is more common in the ectopic ACTH syndrome because ectopic tumors produce more ACTH and other peptides. The combination of Cushing’s syndrome and hyperpigmentation may be an indication of a serious condition.
