UMEM Educational Pearls

Category: Endocrine

Title: Cushing Syndrome

Keywords: Cushing Syndrome (PubMed Search)

Posted: 8/9/2009 by Michael Bond, MD (Updated: 9/5/2009)
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Cushing Syndrome

The most common cause of Cushing syndrome is the use of exogenous glucocorticoids, and it is rarer to have a problem with the hypothalamic-pituitary-adrenal axis.

These patients can present with:

  • proximal muscle weakness
  • easy bruising
  • weight gain
  • hypertension
  • diabetes
  • impaired immune function
  • infertility or menstrual irregularities

For the emergency department we need to be worried about those on chronic steroids that can not increase their native steroid production in a time of stress which will lead them to adrenal crisis.

Pearls for those with Cushing Syndrome:

  • May have perforated viscous with minimal peritoneal signs
  • Suspectable to fungal infections so consider adding fluconazole to those that are septic
  • Give a large dose of hydrocortisone 100mg PO/IV every 8 hours if you suspect adrenal crisis.