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.