I. Definition/general comments
A. Group of symptoms resulting from hypercortisolism due to numerous causes
B. Excess adrenocorticotropic hormone (ACTH) secretion by the pituitary accounts for 90% of Cushing’s syndrome; it is therefore referred to as Cushing’s disease.
II. Incidence/predisposing factors
A. Excess ACTH production from the pituitary; approximately 70% of cases of Cushing’s syndrome are caused by benign pituitary adenomas
B. Adrenal neoplasms account for approximately 10% to 15% of cases; women are affected more often than men at a 3 to 5:1 ratio.
C. Nonpituitary neoplasms such as small cell lung cancer account for approximately 15% of cases.
D. Excessive glucocorticoid administration, including prolonged use
III. Subjective/physical examination findings
A. Obesity—central with muscle wasting
B. Moon face
C. Emotional lability
1. Depression
2. Anxiety
3. Irritability
D. Buffalo hump
E. Acne
F. Purple striae
G. Protuberant abdomen
H. Hirsutism
J. Hypertension
K. Weakness
L. Backache
M. Headache
N. Amenorrhea/impotence
O. Polyuria
P. Hyperglycemia
Q. Osteoporosis
IV. Diagnostic/laboratory findings
A. Hyperglycemia as evidenced by impaired glucose tolerance testing