We describe the second reported case of a male patient presenting with hypertension and Cushing syndrome with MCMT. [ncbi.nlm.nih.gov]

Clinical description The disease presents a bimodal age distribution with a rare subset presenting in the first years of life, particularly associated to McCune-Albright syndrome (MAS; see this term). [orpha.net]

In our case a mild form of facies lunaris was present and induced us to perform adequate hormonal tests and confirmatory imaging. [omicsonline.org]

These patients usually present at an older age with long standing symptoms. [healio.com]

• Weakness

  Symptoms also include fatigue, weakness, depression, mood swings, increased thirst and urination, and lack of menstrual periods in women. [nadf.us]

  An overproduction of the aldosterone hormone can lead to high blood pressure and to those symptoms associated with low levels of potassium, such as weakness, muscle aches, spasms, and sometimes paralysis. [hopkinsmedicine.org]

  Some symptoms are Upper body obesity Thin arms and legs Severe fatigue and muscle weakness High blood pressure High blood sugar Easy bruising Lab tests can show if you have it and find the cause. [fpnotebook.com]

• Weight Gain

  gain and developmental problems in children One of the biggest signs of Cushing’s disease is unexplained weight gain. [draxe.com]

  gain is commonly seen in Cushing's Syndrome, Cushing's Syndrome itself is a rare cause of weight gain. [columbiasurgery.org]

  Polycystic ovary syndrome can cause excessive hair growth, menstrual abnormalities, weight gain, and even diabetes. [adrenalfatiguesolution.com]

  Hypercortiolism means a high level of the adrenal hormone cortisol, which causes many symptoms including weight gain, high blood pressure, diabetes, osteoporosis, concentration deficit and increased cardiovascular deaths. [sciencedaily.com]

  Weight gain in face ( moon face ) Weight gain above the collar bone (supraclavicular fat pad) Weight gain on the back of neck ( buffalo hump ) Skin changes with easy bruising in the extremities and development of purplish stretch marks ( striae ) particularly [aans.org]

• Fatigue

  Health Diseases Adrenal Fatigue Syndromes Related to Adrenal Fatigue Patients and healthcare providers alike often confuse other syndromes with adrenal fatigue. [dummies.com]

  Some symptoms are upper body obesity thin arms and legs severe fatigue and muscle weakness high blood pressure high blood sugar easy bruising lab tests can show if you have it and find the cause. [icd10data.com]

  Some symptoms are Upper body obesity Thin arms and legs Severe fatigue and muscle weakness High blood pressure High blood sugar Easy bruising Lab tests can show if you have it and find the cause. [fpnotebook.com]

  They include: weakness weight loss anorexia vomiting and diarrhea fatigue depression skin hyperpigmentation. [americannursetoday.com]

  Read Next: 3 Steps to Heal Adrenal Fatigue [draxe.com]

• Swelling

  Her face appeared Cushingoid with periorbital swelling and rubor. Her thyroid was palpable without nodularity. Her abdominal exam revealed visible superficial veins but no striae. [healio.com]

  […] on the back of the neck Increased and lower-extremity swelling The presence of abdominal obesity, particularly the appearance of abdominal striae (think of striae as stretch marks, like in pregnancy) One or more aspects of metabolic syndrome, including [dummies.com]

  Signs High blood pressure Diabetes Moon facies (round facial shape) Buffalo hump (mound of fat at the back of the neck) Stretch marks Abnormal hair growth Osteoporosis Symptoms Easy bruising Fatigue Weight gain (particularly around the mid-section) Leg swelling [saintjohnscancer.org]

  The patient also had a complaint of swelling over face and all over the body since last 2 month. On examination the patient was febrile; tachycardia and tachypnea were also there. [ijem.in]

  Buffalo hump" – a mound of fat forms at the base of the neck Weight gain – especially in the abdomen while the arms and legs become skinny Increased body hair – especially on the arms, face, and around the belly button Thinning skin Acne Easy bruising Leg swelling [columbiasurgery.org]

• Increased Susceptibility to Infections

  An increased susceptibility to infection may also lead to sepsis. Hyperglycemia and hypertension are a common association as it was there in this case. Osteoporosis is common and may cause pathological fracture. [ijem.in]

• Cough

  Here we report a case of iatrogenic Cushing syndrome due to topical steroid application in a 5-month-old female child admitted to the hospital for repeated episodes of fever and cough. [ijem.in]

• Constipation

  […] periods and fertility problems low sex drive abnormal hair growth on the body and face (especially noticeable in women) weakened bones and higher risk for fractures or osteoporosis digestive problems, including bloating/water retention, kidney stones and constipation [draxe.com]

• Hypertension

  We describe the second reported case of a male patient presenting with hypertension and Cushing syndrome with MCMT. [ncbi.nlm.nih.gov]

  Through the years it was not possible to confirm adrenal hyperfunction and the patient was treated considering very common symptoms (obesity, hypertension, osteoporosis ). [omicsonline.org]

  Adrenal hyperfunction (Cushing syndrome) causes excess cortisol secretion by the adrenal gland and manifests in a constellation of symptoms, including central obesity, hypertension, type 2 diabetes, easy bruisability, abdominal striae, and myopathy. [arupconsult.com]

  Patients may also have a history of hypertension and diabetes. [statpearls.com]

• Hirsutism

  It causes characteristic symptoms including obesity of the trunk and thinning of the extremities, a thickening at the base of neck called a buffalo hump, a rounding of the face, weakness of the proximal muscles, thinning of the skin, hirsutism or an increase [surgery.med.miami.edu]

  Bishop Auckland General Hospital, Cockton Hill Road, Bishop Auckland, Co Durham DL 14 6AD, UK; s.nag{at}btopenworld.com Statistics from Altmetric.com adrenocortical carcinoma Cushing’s syndrome A 46 year old woman presented with a short history of hirsutism [pmj.bmj.com]

  […] myopathy depression and other mood disorders osteoporosis hypertension hyperglycemia and development of overt diabetes mellitus immunosuppression and recurrent infections Female patients with Cushing syndrome may also have signs of androgen excess (e.g. hirsutism [radiopaedia.org]

  Metyrapone is started at 250 mg P.O. three times daily (dosage may be increased up to 6 g/day); common adverse effects include hypertension, hirsutism, nausea, vomiting, and edema. [americannursetoday.com]

  Physical examination of the patient will reveal increased fat deposits in the upper half of the body leading to "Buffalo torso," characteristic moon facies (earlobes are not visible when viewed from the front), thin arms and legs, acne, hirsutism, proximal [statpearls.com]

• Skin Atrophy

  atrophy, striae, and a predisposition to life-threatening infections. [3] Cushing syndrome is having multisystem presentation affecting every organ system. [ijem.in]

• Osteoporosis

  The prolonged catabolism of proteins causes purplish striae of the torso, osteoporosis and poor wound healing. All these processes involve collagen which is a three amino based protein. [statpearls.com]

  It is characterized by upper body OBESITY; OSTEOPOROSIS; HYPERTENSION; DIABETES MELLITUS; HIRSUTISM; AMENORRHEA; and excess body fluid. [fpnotebook.com]

  She was overweight (height 153 cm, weight 65 kg BMI=27), non-smoker, and suffered diffuse mild joint pain with osteoarthritis and osteoporosis. [omicsonline.org]

  It is characterized by upper body obesity; osteoporosis; hypertension; diabetes mellitus; hirsutism; amenorrhea; and excess body fluid. [icd10data.com]

  […] obesity of the trunk and thinning of the extremities, a thickening at the base of neck called a buffalo hump, a rounding of the face, weakness of the proximal muscles, thinning of the skin, hirsutism or an increase in hair, easy bruisability, depression, osteoporosis [surgery.med.miami.edu]

• Muscle Weakness

  Some symptoms are upper body obesity thin arms and legs severe fatigue and muscle weakness high blood pressure high blood sugar easy bruising lab tests can show if you have it and find the cause. [icd10data.com]

  Some symptoms are Upper body obesity Thin arms and legs Severe fatigue and muscle weakness High blood pressure High blood sugar Easy bruising Lab tests can show if you have it and find the cause. [fpnotebook.com]

  An overproduction of the aldosterone hormone can lead to high blood pressure and to those symptoms associated with low levels of potassium, such as weakness, muscle aches, spasms, and sometimes paralysis. [hopkinsmedicine.org]

  Symptoms may include: upper body obesity round face increased fat around neck thinning arms and legs fragile and thin skin stretch marks on abdomen, thighs, buttocks, arms, and breasts bone and muscle weakness severe fatigue high blood pressure high blood [adrenaltumors.org]

• Bone Pain

  […] changes include: Backache, which occurs with routine activities Bone pain or tenderness Collection of fat between the shoulders and above the collar bone Rib and spine fractures caused by thinning of the bones Weak muscles, especially of the hips and [medlineplus.gov]

  Decreased IL-2 levels prevent the proliferation of T-lymphocytes. [9] History and Physical Patients may have a history of weight gain, fatigue, weakness, delayed wound healing, easy bruising, back pain, bone pain, loss of height, depression, mood swings [statpearls.com]

• Anxiety Disorder

  Your patient has an anxiety disorder on medication and a history of opiate dependence. [endotext.org]

  such as affective and anxiety disorders or cognitive dysfunctions," according to a recently published paper on the topic. 7 Patients should be screened with self-report questionnaires such as the Beck Depression Inventory and the Hospital Anxiety and [endocrinologyadvisor.com]

  People with anxiety disorders or depression, poorly controlled diabetes, excessive alcohol users, or very obese may have this disorder but not require treatment to the endocrine glands. [adrenalfatiguesolution.com]

  These people may have pseudo-Cushing's syndrome, a condition sometimes found in people who have depression or anxiety disorders, drink excess alcohol, have poorly controlled diabetes, or are severely obese. [endocrine.surgery.ucsf.edu]

• Loss of Libido

  […] of libido, testicular atrophy and gynecomastia Large tumors with Cushing syndrome or Cushing syndrome with obvious virilization and marked 17-ketosteroid excretion are usually carcinomas High cortisol levels, low ACTH levels Opposite adrenal gland is [pathologyoutlines.com]

  emotional reactivity, loss of libido, erectile dysfunction in males, irregular menstrual cycles in females, infertility, hyperhidrosis, hirsutism, biparietal visual loss if there is a large pituitary adenoma, recurrent fungal and bacterial infections [statpearls.com]

  Lack of sex drive (loss of libido). Periods may become irregular, or stop, in women. 'Thinning' of the bones (osteoporosis). You may fracture a bone more easily than usual. 'Water retention' (oedema) around the ankles. Excess thirst. [patient.info]

• Amenorrhea

  It is characterized by upper body OBESITY; OSTEOPOROSIS; HYPERTENSION; DIABETES MELLITUS; HIRSUTISM; AMENORRHEA; and excess body fluid. [fpnotebook.com]

  It is characterized by upper body obesity; osteoporosis; hypertension; diabetes mellitus; hirsutism; amenorrhea; and excess body fluid. [icd10data.com]

  […] buffalo hump) Skin changes with easy bruising, purplish stretch marks (stria) and red cheeks (plethora) Excess hair growth (hirsutism) on face, neck, chest, abdomen, and thighs Generalized weakness and fatigue Loss of muscle Menstrual disorders in women (amenorrhea [pituitary.org]

  […] on the abdomen), thinning of the skin that leads to spontaneous bruising, muscle weakness and wasting, back pain, osteopenia and osteoporosis, depression and other psychological symptoms, hypertension, and menstrual disturbances ( oligomenorrhea and amenorrhea [britannica.com]

  Patients often present with increased hair growth (hirsuitism), increased muscle mass, acne and amenorrhea (loss of periods in a female). A feminizing adrenal tumor makes excess estrogen. [uofmhealth.org]

• Headache

  […] changes Thinning of the skin Easy bruising Acne or superficial skin infections Purple striations on the skin of the abdomen, thighs, and breasts High blood pressure Weakness (often noticed when trying to stand up or to raise hand above head) Backache Headache [uclahealth.org]

  […] of Cushing syndrome) Periods that become irregular or stop Men may have: Decreased or no desire for sex (low libido) Erection problems Other symptoms that may occur include: Mental changes, such as depression, anxiety, or changes in behavior Fatigue Headache [medlineplus.gov]

  If you are experiencing these symptoms in combination with any of the other signs including fatigue, a new rise in blood pressure, emotional changes, or headaches, a trip to your doctor would be prudent. [adrenalfatiguesolution.com]

  He reports insomnia, headaches, leg weakness, decreased appetite, loss of smell, and chronic back pain. [endotext.org]

Diagnosis is challenging, but an initial workup includes cortisol and dexamethasone suppression testing. [arupconsult.com]

Addison Disease Workup. Available online at http://emedicine.medscape.com/article/116467-workup. Accessed Sept. 20, 2012. (April 2012) Cushing’s Syndrome. National Endocrine and Metabolic Diseases Information Service. [labtestsonline.org]

[…] particularly around the mid-section) Leg swelling Mood swings Irregular periods Muscle weakness Mental fogginess Diagnosis Diagnosis of Cushing’s Syndrome Diagnosis is made by a series of blood, salivary, and sometimes urine tests along with imaging (workup [saintjohnscancer.org]

[…] ovarian tumors adrenocorticotropin (ACTH)-independent macronodular adrenocortical hyperplasia (AIMAH) : rare cause of ACTH-independent Cushing syndrome 4 corticotropin-releasing hormone-secreting tumor: very rare hypothalamic tumors ectopic production The workup [radiopaedia.org]

[…] be driven by increased secretion of hypothalamic corticotropin-releasing hormone, which is suppressed in Cushing's syndrome. 5 Causes and Diagnosis If Cushing's syndrome is suspected on the basis of the patient's physical appearance, the diagnostic workup [endocrinologyadvisor.com]

• Adrenocortical Hyperplasia

  hyperplasia (AIMAH) - also known as massive macronodular adrenocortical disease (MMAD). [ncbi.nlm.nih.gov]

  Review Summary Nature Reviews Endocrinology 2007年11月1日 Genetics of adrenal tumors associated with Cushing's syndrome: a new classification for bilateral adrenocortical hyperplasias 検索語として「副腎腫瘍（adrenal tumors）」「クッシング症候群（Cushing syndrome）」「プロテインキナーゼA（protein [natureasia.com]

  Cushing disease) ectopic production: 15% 5 lung cancer: small cell lung cancer, bronchial carcinoid small cell cancers of the thymus pancreatic neuroendocrine tumor pheochromocytoma benign ovarian tumors adrenocorticotropin (ACTH)-independent macronodular adrenocortical [radiopaedia.org]

  There are several causes of Cushing syndrome : Adrenocortical hyperplasia (overgrowth of adrenal cortex) secondary to pituitary overproduction of adrenocorticotrophic hormone (ACTH) Benign or malignant adrenal tumours that release excess glucocorticoids [dermnetnz.org]

  Keywords Adrenocortical Carcinoma Adrenal Adenoma Carney Complex Primary Pigment Nodular Adrenocortical Disease Bilateral Adrenal Hyperplasia These keywords were added by machine and not by the authors. [link.springer.com]

Other laboratory tests What is the treatment for Cushing's syndrome? Treatment for Cushing's syndrome depends on its cause. Surgery may be needed to remove tumors or the adrenal glands. [hopkinsmedicine.org]

It could be a useful tool in this context because it might provide information to guide the treatment. [ncbi.nlm.nih.gov]

Management and treatment Treatment can be medical if aberrant adrenal receptors are identified and can be blocked (i.e. with propranolol, somatostatin or GnRH analogs). [orpha.net]

Treatment of overactive adrenal glands Treatment of overactive adrenal glands depends on the cause of the disease. [stanfordchildrens.org]

Prognosis Prognosis after treatment is good but quality of life may be affected due to the long-term effects of hypercortisolemia. Without treatment the disease is life-threatening as in the case of manifest hypercortisolism. [orpha.net]

Expectations (prognosis): Patients with adrenal adenoma who undergo surgery have an excellent prognosis. Surgery success rates are very high with this type of tumor. For adrenal carcinoma, surgery is sometimes not possible. [uclahealth.org]

The prognosis is worsened in the setting of an unresectable hormone-secreting tumor. [statpearls.com]

Follow Up Prognosis and Follow Up Over time, many of your symptoms should go away; weight loss, bruising, and face shape generally happen first. However, your body needs time to re-regulate itself, so these changes are not going to happen overnight. [saintjohnscancer.org]

Outlook (Prognosis) People with an adrenal tumor who have surgery have an excellent outlook. For adrenal cancer, surgery is sometimes not possible. When surgery is performed, it does not always cure the cancer. [ufhealth.org]

Etiology The exact etiology is unknown but the adrenal overgrowth seen in AIMAH may be due to the expression of aberrant membrane receptors found in the adrenal cortex that regulate cortisol secretion and which are stimulated by gastric inhibitory polypeptide [orpha.net]

Treatment and prognosis Management depends on the specific etiology 6. [radiopaedia.org]

Epidemiological data, medical history, and hormonal parameters depending on the etiology of hypercortisolism were collected and compared to the duration of adrenal insufficiency. [ncbi.nlm.nih.gov]

ACTH-dependent cortisol excess due to a pituitary adenoma is called Cushing disease, and it is responsible for 80% of endogenous Cushing syndrome. [1] [2] [3] Etiology There are two main etiologies of Cushing syndrome: endogenous hypercortisolism and [statpearls.com]

[…] granular to homogenous, due to accumulation of intermediate filaments Adrenal gland changes: exogenous cortisol causes low ACTH, which causes atrophy of fasciculata and reticularis, not glomerulosa, in residual or opposite adrenal gland Pathophysiology / etiology [pathologyoutlines.com]

Epidemiological data, medical history, and hormonal parameters depending on the etiology of hypercortisolism were collected and compared to the duration of adrenal insufficiency. [ncbi.nlm.nih.gov]

Summary Epidemiology Prevalence of endogenous CS is estimated at 1/26,000 and AIMAH represents less than 1% of the cases. [orpha.net]

Cushing's syndrome: epidemiology and developments in disease management. Clin Epidemiol 2015; 7:281–293 [Google Scholar] 8. Steffensen C, Bak AM, Rubeck KZ, Jorgensen JO. Epidemiology of Cushing's syndrome. [ajronline.org]

Epidemiology and clinical manifestations of Cushing’s syndrome, 2014. UpToDate: Wolters Kluwer Health Cushing’s syndrome/ disease, 2013. [center4research.org]

Cushing's syndrome: epidemiology and developments in disease management. Clin Epidemiol. 2015;7:281-293. doi:10.2147/CLEP.S44336 National Institutes of Health: Eunice Kennedy Shriver National Institute of Child Health and Human Development. [endocrinologyadvisor.com]

A recent pathophysiological study showed that cortisol production was regulated by aberrant membrane receptors and by corticotropin produced within the adrenocortical tissue. [ekjm.org]

Pathophysiology of disease: disorders of the hypothalamus & pituitary gland. Access Medicine Web site. http://www.accessmedicine.com/content.aspx?aID=2090603. Accessed July 30, 2009. 7. Else T, Hammer GD, Lingappa VR. [aboutcushings.com]

[…] changes from granular to homogenous, due to accumulation of intermediate filaments Adrenal gland changes: exogenous cortisol causes low ACTH, which causes atrophy of fasciculata and reticularis, not glomerulosa, in residual or opposite adrenal gland Pathophysiology [pathologyoutlines.com]

This chapter will focus on the pathophysiology, clinical presentation, evaluation and management of these disorders. [link.springer.com]

Knowing this means that researchers might be able to develop drugs that interrupt the receptors for these hormones and possibly even prevent the benign tissue from developing in the first place. [sciencedaily.com]

At the time of discharge, the patient should have a dietary consult and how to prevent osteoporosis. The pharmacist should educate the patient on the prevention of peptic ulcer disease, diabetes, and weight gain. [statpearls.com]

Because glucocorticoids suppress the immune system, they reduce inflammation and are also frequently given to people who have had organ transplants to prevent the immune cells from attacking the transplant. [endocrinediseases.org]

Prevention: Use caution when taking corticosteroid medications. Appropriate treatment of adrenal tumors may reduce the risk of complications in some patients with tumor-related Cushing's syndrome. [uclahealth.org]

Prevention Appropriate treatment of adrenal tumors may reduce the risk of complications in some people with tumor-related Cushing syndrome. Images References Nieman LK, Biller BM, Findling JW, et al. [ufhealth.org]