Clinical Features

The clinical manifestations of Cushing's syndrome usually begin gradually (Table 70-1). Patients frequently report increasingly severe asthenia, enhanced appetite, and weight gain. In premenopausal women, oligomenorrhea is common and may occur before any other apparent clinical change. Typically, these patients have centripetal obesity with "moon face," fullness of the supraclavicular fat pads, and a "buffalo hump." The limbs look thin in relation to the rest of the body, and muscular hypotrophy accentuates this characteristic appearance (Fig. 70-1A). Subsequently, skin changes take place: the epidermidis and subcutaneous tissue become thinner, and purplish red striae can be seen on the flanks, the abdomen, and the limbs. The skin becomes fragile, with loss of its elasticity, and extensive bruising is common even after only minimal injury (Fig. 70-1B). Mild or moderate arterial hypertension is quite characteristic of Cushing's syndrome and occurs in 70% of patients, as does osteoporosis. More rarely, pathologic fractures, muscular weakness, renal stones, polyarthralgia, and, in some cases, neuropsychiatric signs and symptoms occur. Laboratory abnormalities are listed in Table 70-2. An abnormal oral glucose tolerance test, postprandial hypoglycemia, and secondary hyperinsulinemia are relatively common. The most frequently observed case is that of an obese women 30 to 35 years old,

TABLE 70-1. Clinical Manifestations in Cushing's Syndrome

TABLE 70-2, Metabolic Manifestations in Cushing's Syndrome

Signs and Symptoms % Signs and Symptoms %

Obesity 90

Hypertension 80 Menstrual disorders 70

Hirsutism 70

Facial plethora 70

Neuropsychiatrie SO symptoms

Impotence 60

Muscular weakness 60

Cutaneous striae 60

Bruising 40

Acne 30

Headache 10

Metabolic Manifestations

Metabolic Manifestations

Hyperlipidemia 70

Abnormal OGTT 70

Lymphocytopenia, 50 eosinopenia

High hematocrit and 40

hemoglobin

Hypercalciuria 30

Diabetes 15

OGTT = oral glucose tolerance test.

with oligomenorrhea, slight hirsutism, and moderate arterial hypertension. Today, because of the precision of laboratory and imaging studies, Cushing's syndrome is being diagnosed earlier in its course, so that clinical and laboratory manifestations are less apparent. Representative patients with cortisol-secreting adrenal adenomas treated during the years 1980 to 1990 are shown in Figure 70-2.

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