Table 1.
Clinical Features of Cushing’s Syndrome (% Prevalence) and Their Physiological Causes
| Clinical feature | Physiological basis of effecta |
|---|---|
| General | |
| Obesity 90% | Hyperphagia; insulin resistance |
| Hypertension 85% | Sodium retention (via MR) |
| Skin | |
| Plethora 70% | Thinning of skin (connective tissue) |
| Hirsutism 75% | Androgen excess |
| Striae 50% | Thinning of skin (connective tissue) |
| Acne 35% | Androgen and glucocorticoid excess |
| Bruising 35% | Thinning of skin (connective tissue) |
| Musculoskeletal | |
| Osteopenia 80% | Increase in bone resorption |
| Weakness 65% | Catabolic effect on muscle |
| Neuropsychiatric 85% | CNS effects |
| Emotional lability | Cortisol excess |
| Euphoria | Cortisol excess |
| Depression | Cortisol excess |
| Psychosis | Cortisol excess |
| Gonadal dysfunction | Inhibition of gonadotroph function |
| Menstrual disorders 70% | Inhibition of GnRH, LH, and FSH release |
| Impotence, decreased libido 85% | Inhibition of GnRH, LH, and FSH release |
| Metabolic | |
| Glucose intolerance 75% | Insulin resistance |
| Diabetes 20% | Insulin resistance |
| Hyperlipidemia 70% | Increased lipolysis, hepatic steatosis, insulin resistance |
| Polyuria 30% | Increased GFR; suppression of AVP |
| Kidney stones 50% | urine: ↑ calcium, uric acid, oxalate, ↓ citrate |
| Pediatricb | |
| Growth retardation (83%) | Inhibition of GH secretion (see Fig. 2) |