All are features of Cushings disease except,

Episodic hypeension Hypeension is seen in cushing's syndrome because of sodium and water retention so it is sustained hypeension (not paroxysmal). FEATURES OF CUSHINGS'S SYNDROME Most of the signs symptoms of Cushing's syndrome occur due to known actions of glucocoicoids : - Effect of glucocoicoids Symptoms produced On Protein metabolism Increased mobilization of protein from * The loss of proteins from the muscle in paicular the tissues except the liver causes severe weakness usually in proximal muscles Even the protein collagen fibres in the subcutane? ous tissue are diminished so that the subcutaneous tissue tear easily resulting in development of large purplish striae Q where they have torn apa. On Glucose metabolism * Severely diminished protein deposition in the Stimulation of gluconeogenesis bones often causes severe osteoporosisQ with Decreased glucose utilization by the cells consequent weakness of bones Elevated blood glucose concentration and "adrenal diabetes"2 On Na+ and water homoestasis Glucocoicoids are present in such large * Salt and water retention leads to hypeension. amounts in Cushing's syndrome that they may (llypernatrentia)Q Edema exe a significant mineralocoicoid action * Significant K+ depletion (llypokalensia)Q On bone metabolism Excess bone metabolism causes decrease in Osteoporosis bone formation and increase in bone resorption On fat metabolism Characteristic deposition of fat. The reason for * A special characteristic of Cushing's syndrome is this characteristic deposition is not known but mobilization offal from the lower pa of the body is most probably due to insulin resistance or with concomitant extradeposition of fat in the tho? elevated insulin levels racic and upper abdominal regions giving rise to a buffalo e torso. The excess secretion of steroid also leads to an edematous appearance of the face and the androgenic potency of some hormones sometbnes causes acne and hirsutism. This appearance o fface is called "uwonfacies". On sex hormones Increased secretion of adrenal androgens * HirsuitismQ (often accompanies increase in glucocoicoid * Facial acne secretion) * OligornenorrhoeaQ * Amenorrhoeadeg On C. N. S Excess glucocoicoid accelerates the basic * Increase appetite electroencephalographic rhythm * Insomnia EuphoriaQ Frank psychosisQ