Cushing Moon-faced

Differential diagnoses include diabetes mellitus and metabolic syndrome because patients with these conditions share several similar characteristics with Cushing s syndrome patients (e.g., obesity, hypertension, hyperlipidemia, hyperglycemia, and insulin resistance). In women, the presentations of hirsutism, menstrual abnormalities, and insulin resistance are similar to those of polycystic ovary syndrome. Cushing s syndrome can be differentiated from these conditions by identifying the classic signs and symptoms of truncal obesity, "moon faces" with facial plethora, a "buffalo hump" and supraclavicular fat pads, red-purple skin striae, and proximal muscle weakness. 

Patients with Cushing s syndrome may have the classic physical features of moon face, buffalo hump, hirsutism, and abdominal striae. 

Corticosteroids should be used cautiously in the presence of congestive heart failure, myocardial infarction, hypertension, diabetes mellitus, epilepsy, glaucoma, hepatic disorders, osteoporosis, peptic ulceration, and renal impairment. Children are more susceptible to these adverse effects. To avoid cardiovascular collapse, steroids must be given slowly by intravenous injection. Large doses produce Cushing s syndrome (with moon face and sometimes hirsutism). 

John F. Kennedy) T synthesis in Cushing s syndrome (moon-face)... 

The most common side effects of systemic corticosteroids include behavior disturbances, insomnia, weight gain, and Cushing s syndrome (moon face, buffalo hump, hirsutism, obesity, and easy bruising). Other reactions related to the dose and duration of corticosteroid treatment include hyperglycemia, fluid retention, HTN, electrolyte imbalances. 

In 1912 Harvey Cushing first described a 23-year-old woman with hirsutism, obesity, and amenorrhea and called it a polyglandular syndrome with pituitary involvement Cushing s syndrome is the result of autonomous, excessive production of cortisol leading to classic symptoms characteristic of this disorder. The clinical picture includes truncal obesity, moon face, hypertension, hirsutism,... 

Patients with secondary hypertension may complain of symptoms suggestive of the underlying disorder, but some are asymptomatic. Patients with pheochromocytoma may have a history of paroxysmal headaches, sweating, tachycardia, and palpitations. Over half these patients suffer from episodes of orthostatic hypotension. In primary aldosteronism, symptoms related to the hypokalemia usually include muscle cramps and muscle weakness. Patients with Cushing s syndrome may complain of weight gain, polyuria, edema, menstrual irregularities, recurrent acne, or muscular weakness and have several classic physical features (e.g., moon face, buffalo hump, hirsutism, and abdominal striae). 

The oversecretion of hormone molecules is most often caused by a tumor. Several types of pituitary tumor cause endocrine diseases. For example, one of the most common causes of Cushing s disease is an abnormal proliferation of ACTH-producing cells. Cushing s disease is characterized by obesity, hypertension, and elevated blood glucose levels. Patients with Cushing s disease develop a characteristic appearance a puffy moon face and a buffalo hump caused by fat deposits between the shoulders. Occasionally, Cushing s disease is caused by adrenocortical tumors. 

The condition of excessive GC production is known as Cushing s disease, which is characterized by a typical moon face appearance. This results from loss of muscle mass and changes in body fat distribution. 

The accumulation of fat is highly selective in Cushing s disease the obesity spares the extremities and involves instead the subclavicular region, where it forms what is called the buffalo hump. The facial changes are typical in patients affected with Cushing s syndrome (see Fig. 8-19). Wrinkles disappear, and the face becomes round. The lips form what has been described as a fish mouth, and the plump appearance of the face has brought clinicians to describe these patients as moon-faced. 

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