CUSHING’S SYNDOME

Constellation of signs and symptoms caused by chronic glucocorticoid (steroid) excess, from excessive secretion or,
more commonly, from chronic glucocorticoid therapy.

Causes

  • Iatrogenic (steroid treatment)
  • Cushing’s Disease
  • Adrenal adenoma, adrenal carcinoma

Clinical Features

  • Central (truncal) obesity, moon face, buffalo hump
  • Thinning of the skin, striae
  • Poor wound healing, muscle weakness and atrophy
  • Hirsutism and acne (females)
  • Hypertension and hyperglycaemia

Differential diagnosis

  • Ordinary obesity
  • Alcoholism (alcohol-induced pseudo-Cushing’s syndrome)

Investigations

  • Drug history
  • Refer to higher level for hormonal tests (dexamethasone suppression test) if no history of steroid overuse

Management

Iatrogenic

  • Slowly decrease steroid dose by 2.5-5 mg every 1 to 2 weeks

Non-iatrogenic

  • Refer non-iatrogenic Cushing’s, or iatrogenic cases with complications to higher level of care