Case history
Case history #1
A 34-year-old woman presents with complaints of weight gain and irregular menses for the last several years. She has gained 20 kg over the past 3 years and feels that most of the weight gain is in her abdomen and face. She notes bruising without significant trauma, difficulty rising from a chair, and proximal muscle wasting. She was diagnosed with type 2 diabetes and hypertension 1 year ago.
Case history #2
A 54-year-old man presents for evaluation of an incidentally discovered adrenal nodule. He underwent a computed tomography scan of the abdomen for evaluation of abdominal pain, which was negative except for a 2 cm well-circumscribed, low-density (2 Hounsfield units) nodule in the right adrenal gland. He reports weight gain of 15 kg over the past 4 years. He has difficult-to-control type 2 diabetes and hypertension. He has had two episodes of renal colic in the last 5 years.
Other presentations
Cushing syndrome presents with a variety of non-specific signs and symptoms. Several features have higher specificity, such as violaceous striae, easy bruising, facial plethora, proximal muscle weakness, and unexplained osteoporosis.[8][9] Presentation largely depends on the degree of hypercortisolism. Patients with severe and prolonged hypercortisolism develop more severe manifestations and complications. Patients with Cushing syndrome caused by the ectopic adrenocorticotrophic hormone syndrome generally have higher cortisol levels, and may develop severe muscle wasting, profound hypokalaemia, excessive striae, and severe hyperglycaemia. Additionally, rapid virilisation in females (rapid-onset or increased hirsutism, voice deepening, and clitoral enlargement) in the setting of cortisol excess suggest adrenal carcinoma.[10] Cushing syndrome in pregnancy may be difficult to diagnose due to overlapping features with pre-eclampsia and gestational diabetes, so it is important to have a high index of suspicion. Pregnant patients may present with features such as weight gain, hypertension, easy bruisability, violaceous striae, extremity oedema, and hirsutism. A common presentation in children is growth deceleration with accompanying weight gain. Less common clinical features include multiple renal stones, osteoporosis in younger people, or hypokalaemia without other features suggestive of Cushing syndrome.[Figure caption and citation for the preceding image starts]: Abdominal striae in pregnancyFrom BMJ Case Reports 2011; doi:10.1136/bcr.01.2011.3720 [Citation ends].
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