Cushing’s syndrome

1. Big picture

Cushing’s syndrome = chronic exposure to excess glucocorticoids, especially cortisol. The exam pattern is:

central obesity + moon face + supraclavicular/dorsocervical fat pad + purple wide striae + proximal muscle weakness + hypertension + diabetes/insulin resistance + osteoporosis + infections

The most common cause overall is iatrogenic glucocorticoid use. Among endogenous causes, the most common is usually Cushing disease, meaning an adrenocorticotropic hormone (ACTH)-producing pituitary adenoma.

Important distinction:

• Cushing’s syndrome = any cause of cortisol excess.
• Cushing disease = pituitary ACTH-producing adenoma causing cortisol