Examination: Cushing's Syndrome

Examining a patient for signs of Cushing's Syndrome involves an general inspection of the patient, along with a systematic examination of the main organs involved in the disease

  • Wash your hands
  • Introduce yourself
  • Ask permission to examine patient
  • Expose patient, preferably in underwear
  • Reposition patient lying down

General Inspection:
  • The patient as a whole (for the 'gestalt' picture of Cushing's syndrome):
    • For central obesity
    • For stooped posture (due to osteoporotic damage)
  • Generalised changes over the body, including:
    • Easy bruising
    • Striae
    • Thin skin
    • Classical central fat distribution

Systemic Examination:
  • Examine each of the following body parts separately: (as for the cardiovascular, respiratory and abdominal examinations, start with the hands)

    • Hands and arms for...
      • Bruising
      • Thin arms
      • Ask to measure blood pressure (would be raised)
      • Shoulder abduction power - reduced in proximal myopathy
      • Rheumatoid arthritis (suggesting an iatrogenic cause of the Cushingoid features)

    • Face for...
      • Rounded face (moon face)
      • Visible vessels on the cheeks suggesting thin skin
      • Greasy skin
      • Acne
      • Hirsutism
      • At this point you may wish to test Visual fields (looking for a bitemporal hemianopia that may be the result of an ACTH producing pituitary tumour pressing on the optic chiasm)

    • Shoulders for...
      • Supra-clavicular fat pads
      • Buffalo hump

    • Abdomen for...
      • Central obesity
      • Striae
      • Bruising
      • Renal transplant scars (patient may be on long term steroids which is causing the Cushing's syndrome)

    • Legs for...
      • Skin ulceration
      • Ask patient to get up from a sitting position without using hands to test for proximal myopathy

    • Spine for...
      • Spinal tenderness (may occur with osteoporosis if vertebral fractures)

To end my examination, I would like to:
  • Do bedside tests:
    • Carry out a urine dipstick and check BM blood sugar at bedside (Diabetes Mellitus)
    • Check blood pressure if not already done (Hypertension)
  • Inspect this patient's drug chart for any steroid use.
  • Consider further investigations, such as a dexamethasone suppression test.

written by: celine_lakra; saaid_sufi, first posted on: 1/03/12, 17:00

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