Cushing's Syndrome
Hx
Menstrual Irregularities (81%)
Ex
Wt Gain (90%) Obesity (73%)
Height deceleration (83%)
Facial plethora
Downy hair/Hirsuitism (81%)
Temporal fat pad/round face
Violaceous skin striae (63%)
Acne (52%)
Hypertension (51%)
Fatigue-weakness (45%)
Precocious puberty (41%)
Bruising (27%)
Mental Changes (18%)
“Delayed” bone age (14%)
Hyperpigmentation (13%)
Muscle weakness (13%)
Acanthosis nigricans (10%)
“Accelerated” bone age (10%)
Sleep disturbances (7%)
Pubertal Delay (7%)
Slipped femoral capital epephysis (2%)
Ix
24hr urine free cortisol
Glucose intolerance
Hypercalcemia (6%)
Alkalosis (6%)
Hypokalemia (2%)
Causes
- Iatrogenic steroids (majority)
- > 7yo: ACTH-secreting pituitary adenoma (75% of endogenous ie not iatrogenic)
- <7yo: adrenal tumor (adenoma, carcinoma, or bilateral hyperplasia including nodular ?McCune Albright Syndome)
Rx