By Gary M. White, MD

Cushing disease is caused by excessive secretion of cotricotropin by adenomas of the anterior pituitary gland. Excessive glucocorticoids--endogenous or exogenous--may cause enlargement of the cheeks (moon facies) and a buffalo hump secondary to deposition of fat. The extremities in contrast remain slender and the skin is atrophic and fragile. Corticotropin dependent disease includes Cushing's disease. Corticotropin-independent excess cortisol production by the adrenals may occur unilaterally (e.g. adenoma or carcinoma) or bilaterally (e.g. bilateral nodular adrenocortical hyperplasia).


Typical features include weight gain, centripetal obesity, moon facies, proximal myopathy, psychiatric disturbances and a variety of skin manifestations which include:Violaceous skin stria, acne, hirsutism, acanthosis nigricans, superficial fungal infections (particularly tinea versicolor), hyperpigmentation, and skin thinning with easy bruisability.


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