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Cutaneous manifestations in Cushing's Syndrome: causes, symptoms, diagnosis, treatment
Medical expert of the article
Last reviewed: 04.07.2025
Cushing's syndrome (synonym: Itsenko-Cushing syndrome).
Causes and pathogenesis of Cushing's syndrome. Cushing's syndrome occurs when the level of glucocorticoids in the blood increases. Endogenous Cushing's syndrome is caused by excessive production of cortisol by the adrenal cortex. Excessive production of ACTH is observed in the following conditions: dysfunction of the hypothalamic-pituitary system; micro- and macroadenomas of the pituitary gland secreting ACTH; nodular hyperplasia of the adrenal cortex; tumors (adenoma and cancer) of the adrenal cortex. Endogenous (drug-induced) Cushing's syndrome occurs with long-term treatment (parenterally, orally or locally) with corticosteroids or corticotropin. Skin changes occur due to disruption of the structure of collagen fibers.
Symptoms of Cushing's syndrome. Most patients experience fatigue, muscle weakness, and personality changes. Physical examination reveals obesity, redistribution of fat deposits (face, body, abdomen, suprascapular region), a full-blooded moon face, a fatty hump on the neck, a thick trunk, and thin limbs. Skin atrophy is clearly visible: thinning (atrophy of the epidermis and dermis); ecchymosis with minor injuries, telangiectasia (full-blooded face). There is increased growth of terminal hair on the face and often vellus hair on the face and arms (hypertrichosis), in women - hirsutism and androgenic alopecia. Steroid acne often appears: monomorphic rashes that differ from ordinary acne by an almost complete absence of comedones. In places there is hyperpigmentation due to increased ACTH production. Patients with Cushing's syndrome often have fungal (lichen versicolor, dermatophytes) and viral infections. Associated diseases include arterial hypertension, mental disorders, myopathy, gastrointestinal diseases, osteoporosis, etc.
Differential diagnosis. Cushing's syndrome should be distinguished from obesity and depression.
Treatment of Cushing's syndrome. It is necessary to identify and eliminate the causes of the disease.
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