Rapid Review: Cushing Syndrome

Reviewed February 2024

Cushing Syndrome

• Patient presents with amenorrhea, central obesity, depressive symptoms, and easy bruising
• PE: purple striae, moon face (facial adiposity), buffalo hump (increased adipose tissue in the neck and upper back), and hypertension
• Diagnosis: 24-hour urinary free cortisol, late night salivary cortisol, dexamethasone suppression test, ACTH levels
• Most common noniatrogenic cause is hypercortisolism from ACTH-secreting pituitary tumor
• If cause is pituitary tumor then it’s called Cushing disease

Sample question:

A 35-year-old woman presents to the clinic with decreased libido, weight gain, and menstrual irregularities. She says she has gained 35 pounds in the past three months without any changes in her diet. She has also noticed her face has become more round. Examination shows a dorsal fat pad, hirsutism, and purplish abdominal striae. Which of the following is the most likely diagnosis?