Table 17.1Clinical features of Cushing’s syndrome of whatever cause in order of frequency
| Plethoric, ‘moon face’ |
| Central obesity |
| Impaired glucose tolerance or diabetes |
| Hypertension |
| Menstrual irregularity (women), erectile dysfunction (men) |
| Osteoporosis |
| Purple striae, particularly over abdomen, and tendency to bruise easily |
| Proximal myopathy |
| Hirsutism and frontal alopecia (women, indicating androgen excess) |
| Ankle oedema |
| Interscapular fat pad |
| Acne |
| Musculoskeletal aches and pains |
| Depression |
| Poor wound healing |
| Kyphosis secondary to osteoporosis |
| Polycythaemia |
Cushing’s syndrome is the name given to the clinical symptoms and physical signs induced by glucocorticoid excess (Fig. 17a; Table 17.1). It may be caused by excess adrenocorticotrophic hormone (ACTH) secretion by a pituitary tumour resulting in bilateral adrenocortical hyperplasia or by adrenal cortical tumours such as benign adenomas or malignant carcinomas (Fig. 17b
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