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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.