Which clustering of symptoms is typical of Cushing syndrome due to prolonged glucocorticoid use?

Which clustering of symptoms is typical of Cushing syndrome due to prolonged glucocorticoid use?

• A. Weight gain and hypertension.
• B. Weight gain especially in the face, neck, and abdomen with easy bruising and striae.
• C. Hyperpigmentation with hypotension.
• D. Weight loss with fatigue.

Answer: (B)

Prolonged glucocorticoid use causes a Cushingoid presentation, where excess cortisol re-distributes fat and weakens tissues. The most telling pattern is central (truncal) weight gain with a round face and often a dorsocervical fat pad, plus thinning skin that bruises easily. The abdominal skin becomes fragile, leading to wide, purple striae. These skin and fat distribution changes, together with easy bruising from impaired collagen, are the hallmark features of iatrogenic Cushing syndrome. Hypertension can accompany this picture, but the combination of facial/central obesity with easy bruising and abdominal striae is the classic cluster that points to glucocorticoid excess. By contrast, hyperpigmentation with hypotension suggests Addison disease, and weight loss with fatigue points away from glucocorticoid excess.

Prolonged glucocorticoid use causes a Cushingoid presentation, where excess cortisol re-distributes fat and weakens tissues. The most telling pattern is central (truncal) weight gain with a round face and often a dorsocervical fat pad, plus thinning skin that bruises easily. The abdominal skin becomes fragile, leading to wide, purple striae. These skin and fat distribution changes, together with easy bruising from impaired collagen, are the hallmark features of iatrogenic Cushing syndrome. Hypertension can accompany this picture, but the combination of facial/central obesity with easy bruising and abdominal striae is the classic cluster that points to glucocorticoid excess. By contrast, hyperpigmentation with hypotension suggests Addison disease, and weight loss with fatigue points away from glucocorticoid excess.