Cushing syndrome

Published on 02/04/2015 by admin

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Last modified 02/04/2015

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145 Cushing syndrome

Instruction

Examine this patient.

Look at this patient’s face.

Salient features

History

• History of steroid therapy

• Central weight gain

• Hirsutism (p. 602)

• Easy bruising

• Acne

• Weakness of muscle

• Menstrual disturance

• Loss of libido

• Depression, sleep disturbances

• Back pain as a result of spinal osteoporosis.

Examination

• Moon-like facies (Fig. 145.1), acne, hirsutism and plethora (from telangiectasia).

• Examine the following:

• The mouth for superimposed thrush
• The interscapular area for ‘buffalo hump’
• Increased fat pads and bulge above supraclavicular fossae (more specific for Cushing syndrome)
• The abdomen for thinning of skin and purple striae (also seen over the shoulders and thighs): said to be present on almost all patients
• The limbs for bruising, wasting of the limbs, weakness of the muscles of the shoulders and hips: get the patient to squat (proximal myopathy).

• Ask the patient whether he or she has back pain and then examine the spine, looking for evidence of osteoporosis and collapse of vertebra, kyphoscoliosis.

• Measure the BP.

• Tell the examiner you would like to:

• test the urine for glucose
• check visual fields (for pituitary tumour).
• examine the fundus for optic atrophy, papilloedema, signs of hypertensive or diabetic retinopathy.

• Comment on signs of asthma, rheumatoid arthritis, SLE, fibrosing alveolitis (as these are conditions that are treated with long-term steroids).

image

Fig. 145.1

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