Clinical state from chronic glucocorticoid excess, most commonly exogenous steroids.
Clinical features
- • Central obesity, moon face, buffalo hump
- • Proximal myopathy
- • Purple striae, easy bruising
- • Hypertension, diabetes, osteoporosis
Investigations
- • Screen: overnight 1 mg dexamethasone suppression, late-night salivary cortisol, 24 h urinary free cortisol (2 abnormal tests)
- • Then ACTH: suppressed = adrenal; normal/high = pituitary or ectopic
- • High-dose dexamethasone suppression, pituitary MRI, inferior petrosal sinus sampling
Management
- • Stop/taper exogenous steroid where possible
- • Transsphenoidal surgery for Cushing's disease
- • Adrenalectomy for adrenal adenoma
- • Metyrapone/ketoconazole as medical bridge
Clinical pearls
- • Pseudo-Cushing's from alcohol, obesity and depression can mimic biochemistry
- • Screen for VTE — hypercoagulable state
Educational — verify locally.
