Cushing Syndrome

* Clinical syndrome resulting from excess circulating glucocorticoid

Causes
1) Exogenous: Steroid Toxicity (Tx for Nephrotic, SLE, JRA, IBD) 
2) Endogenous : Adrenal CA/Adenoma, CAH, Cushing disease, Ectopic-ACTH

Head-to-Toe Examination ---> Mainly for Exogenous Cause (as a cause for CS)

1) General
    - Orange on stick appearance
    - Central Obesity
    - Hyperpigmentation (ACTH-dep)

2) Face
    - Moon Face, Plethoric Face, Acne, Hirsuitism, Frontal balding (female)

3) Eyes
    - Cataract, Papilloedema (funduscopy)

5) Oral
    - Candidiasis

4) Back
    - Dorsal fat pad, Vertebaral tenderness (osteoporosis)
    - Neck: Skin Infxn

5) Arms
   - Bruises, Thin skin, Skin Infxn (folds area), prox m/s wasting
   - Test for Prox Myopathy

6) Fingers
   - Bad ungual infection

7)) Abdomen
   - Central Obesity, Striae (purple/red), Scar (any reason)
   - Palpate --> Epigastric tenderness (>> steroid usage --> PUD)
   - Check for Ascites

8) Legs
    - Bruises, Thin skin, Thin limbs, Prox m/s wasting
    - Palpate for leg edema also
    - Test for Prox Myopathy

9) Complete with
    - BP --> HPT
    - RBS/ Dipstick --> DM
    - Weight & Height --> Growth Failure
    - Ask Hx of Long Steroid Tx
    - Any Bony pain/ patho# --> Osteoporosis

Graphic presentation of Cushing Syndrome