Table 3.

Reasons why clinicians fail to consider the diagnosis of Cushing’s syndrome

Many of the features of Cushing’s syndrome are common in the general population (Table2).

Signs and symptoms accumulate and often worsen over time, so that the initial presentation may include only one or two features, such as weight gain and irritability.

Features with the greatest specificity for Cushing’s syndrome (ie, uncommon in the general population) such as wide purple striae, thrombotic phenomenon, severe hypokalemia, or fracture tend to occur late, after long exposure, or with the most severe hypercortisolism.

Some features (eg, fractures, amenorrhea, central serous retinopathy) are most likely to be evaluated by practitioners less likely to have experience with Cushing’s syndrome.