Cushing's syndrome focussed exam

Question 1

General inspection

Answer 1

Central adiposity
Intra-scapular fat pad
Hirsutism
OP effects e.g. kyphosis

Around bed: inhalers, nebulisers, oxygen

Question 2

Hands and arms

Answer 2

Capillary glucose marks on finger pulps (secondary diabetes)
Pigmentation (Cushing’s disease)
Deforming polyarthritis (a reason for corticosteroid use)
Thin skin and bruising
Poor wound healing

Question 3

Face

Answer 3

Inspection: cushingoid-like facial features, facial plethora, hirsutism, acne, telangectasia, butterfly rash

Inside mouth: oral thrush, buccal pigmentation (Cushing’s disease)
Listen for hoarse voice
Visual fields (bitemporal hemianopia in pituitary adenoma)

Question 4

Neck

Answer 4

Intrascapular fat pad

Supraclavicular fat pad

Question 5

Chest and abdo

Answer 5

Skin thinning
Classical purple striae
Lipodystrophy from insulin injections (secondary diabetes)
Signs of any conditions requiring prolonged steroid use (e.g. organ transplant scars, hyperexpanded chest in COPD)

Question 6

Finally

Answer 6

Proximal myopathy

Question 7

To complete

Answer 7

BP, dipstick urine for glucose, formally assess visual fields

Full hx
24 hour urinary free cortisol
Overnight / low dose dexamethasone suppression test

Question 8

Generic q (help differentiate Cushing’s from hypothyroidism)

Answer 8

What did you notice first?
Long term conditions requiring steroids?
Changes in appearance?

Changes in mood?
Intolerant of heat or cold?
Any change in periods?