iatroX Rounds #26
The clues
- 1
A 38-year-old woman presents to her GP complaining of a 10 kg weight gain, mostly around her midsection, and irregular periods.
- 2
She mentions that she has developed a hump on her upper back and her face has become noticeably more rounded and red.
- 3
Her blood pressure is 155/96 mmHg and she was recently diagnosed with osteoporosis and impaired glucose tolerance.
- 4
On physical examination, there are prominent purple striae broader than 1 cm on her abdomen and significant bruising on her limbs.
- 5
A midnight salivary cortisol test is significantly elevated on two separate occasions and the 24-hour urinary free cortisol is high.
- 6
The diagnosis is confirmed when her serum cortisol fails to suppress to less than 50 nmol/L after an overnight low-dose dexamethasone suppression test.
Cushing's syndrome is the clinical state resulting from chronic exposure to excessive levels of glucocorticoids. It is characterised by a loss of the normal diurnal rhythm of cortisol secretion and a failure of the hypothalamic-pituitary-adrenal feedback mechanism.
- Truncal obesity with thin limbs and moon facies
- Proximal muscle wasting and skin thinning
- Broad purple abdominal striae and buffalo hump
for education and entertainment. not medical advice.