Cushing’s Syndrome

Cushing’s Syndrome/Glucocorticoid excess:
Symptoms due chronic exposure to endogenous or exogenous glucocorticoids.

Aetiology:
1) Exogenous steroid administration (eg for rheumatological conditions)
2) Endogenous glucosteroid excess (eg tumour)

Clinical features:
“Moon” face; truncal/central obesity; dorsal cervical fat pads (‘buffalo hump’); slender distal extremities; proximal muscle wasting and weakness; thin atrophic skin; poor wound healing; easy bruising; often also have diabetes mellitus/glucose intolerance and hypertension; proximal muscle weakness; osteoporosis; osteonecrosis

Treatment:
Depends on aetiology.
If carcinoma  surgical or mitotane (chemotherapy for selective destruction of adrenocorticol cells)
Drugs can relive symptoms – aminogluethimide and ketoconazole

Involvement of foot:
Poor wound healing.
Proximal muscle weakness is present in 50% at presentation.
Thinning of skin due to protein catabolism

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