The features of Cushing's syndrome are best considered in terms of the physiological effects of glucocortiocoids. Many of the prominent features of severe disease - severe obesity, hypertension, hirsutism and diabetes - are found in non-Cushingoid patients. The most valuable discriminatory features are:
- palpably thin skin with easy bruising and oedema
- proximal myopathy and weakness - difficulty arising from a squatting position may be striking
- growth arrest with obesity in children
- osteoporosis leading to back pain, vertebral collapse, kyphosis, loss of height and rib fractures
- avascular necrosis of the femoral head
Other features:
- weight gain and obesity - distribution is around the trunk and abdomen - buffalo hump - and the face - moon face; supraclavicular fat pads; limbs are relatively thin - "orange on a stick"
- additional skin changes are acne and hirsutism in women, facial plethora and abdominal, breast and thigh striae which are red or purple. Pigmentation suggests elevated ACTH
- hypertension - with associated cardiovascular complications such as ischaemic heart disease
- diabetes - polydyspsia, polyuria; nocturia may occur without elevation in blood glucose
- psychiatric symptoms - depressive psychosis - 20% - to mood lability, insomina and inverted sleep rhythm
Complications associated with elevated cortisol include:
- infection - fungal skin infection and urinary infection
- gonadal dysfunction - impotence in males; oligomenorrhoea in females
- poor wound healing
Weight loss, profound proximal myopathy, pigmentation and hypokalaemic alkalosis suggests ectopic ACTH secretion.