Cushing's syndrome
Background
- Hypercortisolism producing an array of non-specific symptoms
- Exclude exogenous glucocorticoids and pregnancy
Clinical Features
- Cutaneous: easy bruising, friable, striae, hyperpigmentation
- Endocrine
- Androgen excess causing hirsutism, oily skin, increased libido
- Glucose intolerance
- Metabolic: progressive obesity (esp. buffalo hump and supraclavicular fat pads obscuring clavicles)
- Muscle: proximal muscle atrophy, weakness
- Ophthalmologic: cataracts, increased intraocular pressure
- Psychologic: emotional lability, depression, irritability, anxiety, panic attacks, mild paranoia and mania
Differential Diagnosis
Evaluation
- Outpatient: 24h urinary free cortisol or dexamethasone suppression test
Management
- Treat complications (e.g. hyperglycemia) as appropriate
- Typically outpatient/non-ED management
Disposition
- Typically discharge
References
UpToDate
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