Most important features in cushing syndrome is

(Centripetal obesity) (1050- CMDT-10, 2252-2255-H17th)CUSHING SYNDROME (HYPERCORTISOLISM)ESSENTIALS OF DIAGNOSIS* Central obesity, with a plethoric "moon face" "buffalo hump" supraclavicular fat pad, protuberant abdomen, thin extremities, muscle wasting, thin, skin, purple striae, Hirsutism* Psychological changes - frank psychosis* Olegomenorrhagia or amenorrhea (or impotence in male)* Osteoporosis, hypertension, poor wound healing, polyurea, renal calculi, glaucoma* Hyperglycemia, glycosuria, leukocytosis, lymphocytopenia hypokalemia* Elevated serum cortisol and urinary free cortisol, Lack of normal suppression by dexamethasone*** Hypertension is seen in cushing syndrome because of sodium and water retension so it is sustained hypertension (Not episodic)***Interestingly, hypercortisolism without cushing syndrome can occur in - severe depression, anorexia nervosa, alcoholism and familial cortisol resistance, familial lipodystrophy type I patients receiving anti retroviral therapy for HIV-I infection* Earliest manifestation of cushing's syndrome is - Loss of diurmal variation*** Cushing's disease is associated with increased ACTH and increased cortisol* Conn's syndrome is most commonly associated with cortical adenoma*** NELSON SYNDROME - is a disorder characterized by rapid growth of ACTH secreting pituitary adenoma following bilateral adrenalectomy** (which was performed for cushing disease)* Most common cause of Cushing's syndrome is iatrogenic administration of steroids**Frequency of sign & symptoms of cushing syndrome* Typical habitus (centripetal obesity)97%* Personality changes66%* Increased body weight94%* Ecchymosis65%* Fatigability and weakness87%* Proximal myopathy **62%* Hypertension (BP > 150/90)82%* Edema62%* Hirsutism80%* Polyurea polydipsia23%* Amenorrhea77%* Hypertrophy of clitoris19%* Broad violaceous cutaneous striae67%