Cushing's Syndrome: Recognising Chronic Cortisol Excess
Weight gain in unusual places and skin fragility are clues.
Dr. Camille Ferraud
Endocrinologist
- Central obesity with thin limbs
- Moon face, buffalo hump
- Purple skin striae wider than 1 cm
- Easy bruising
- Proximal muscle weakness
- Hypertension and new-onset diabetes
Causes
Most cases are iatrogenic from glucocorticoid therapy. Endogenous causes include pituitary adenomas (Cushing's disease), adrenal tumours, and ectopic ACTH secretion.
Diagnosis
24-hour urinary free cortisol, late-night salivary cortisol and overnight dexamethasone suppression test screen the syndrome. Imaging localises the cause.
Treatment
Surgery of the underlying tumour is curative when feasible. Medical therapy (ketoconazole, metyrapone, osilodrostat) controls cortisol when surgery is delayed or incomplete.
Never abruptly stop long-term steroid therapy: adrenal insufficiency may follow.
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