Urgent management

• establish IV line with IV fluids

• hydrocortisone sodium succinate 200 mg IV

• arrange urgent hospital admission

Cushing's syndrome

The four main causes are:

• iatrogenic—chronic corticosteroid administration

• pituitary ACTH excess

• adrenal tumour

• ectopic ACTH or (rarely) corticotrophin-releasing hormone (CRH) from non-endocrine tumours, e.g. oat cell carcinoma of lung

The clinical features are caused by the effects of excess cortisol and/or adrenal androgens. Clinical features

• proximal muscle wasting and weakness

• central obesity, buffalo hump

• Cushing's facies: plethora, moon face, acne

• abdominal striae

• thin skin, easy bruising

• hypertension

• hyperglycaemia

• menstrual changes, e.g. amenorrhoea

• osteoporosis

• psychiatric changes, especially depression

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