General

• Patients with Cushing's syndrome due either to endogenous or exogenous glucocorticoid excess typically present with similar clinical manifestations.

• Differential diagnoses include diabetes mellitus and the metabolic syndrome, as patients with these conditions share several similar characteristics with Cushing's syndrome patients (e.g., obesity, hypertension, hyperlipidemia, hyperglycemia, and insulin resistance). In women, the presentations of hirsutism, menstrual abnormalities, and insulin resistance are similar to those of polycystic ovary syndrome. Cushing's syndrome can be differentiated from these conditions by identifying the classic signs and symptoms of truncal obesity, "moon facies" with facial plethora, a "buffalo hump" and supraclavicular fat pads, red-purple skin striae, and proximal muscle weakness.

• True Cushing's syndrome also must be distinguished from other conditions that share some clinical presentations (as well as elevated plasma cortisol concentrations) such as depression, alcoholism, obesity, and chronic illness—the so-called pseudo-Cushing's states.

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