## Cushing Syndrome: Clinical Features Recognition ### Overview Cushing syndrome results from chronic glucocorticoid excess and presents with a constellation of metabolic, musculoskeletal, dermatologic, and endocrine manifestations. ### Correct Answer: Increased Bone Mineral Density **Key Point:** Chronic glucocorticoid excess causes **osteoporosis**, NOT osteosclerosis. Cortisol inhibits osteoblast function, reduces calcium absorption, and increases bone resorption, leading to decreased bone mineral density with high fracture risk — particularly in the spine and hip. **High-Yield:** This is a common NEET PG trap. Students often confuse Cushing syndrome (osteoporosis) with conditions causing osteosclerosis (e.g., Paget disease, renal osteodystrophy, sickle cell disease). ### Why the Other Options Are Correct Features | Feature | Mechanism | Clinical Significance | |---------|-----------|----------------------| | **Hypokalemic metabolic alkalosis** | Excess cortisol has mineralocorticoid activity → Na^+^ retention, K^+^ wasting, H^+^ loss | Present in ~50% of ACTH-dependent cases; less common in adrenal adenoma | | **Hirsutism and acne** | Adrenal androgen excess (DHEA-S, androstenedione) | More prominent in ACTH-secreting pituitary or ectopic tumors | | **Impaired glucose tolerance / DM** | Cortisol antagonizes insulin, increases hepatic gluconeogenesis | Occurs in 20–40% of Cushing syndrome patients | ### Clinical Pearl **Vertebral fractures without trauma** are a hallmark of Cushing syndrome and often the presenting complaint in mild cases. Bone loss is rapid and partially reversible with treatment. **Mnemonic — Cushing Syndrome Metabolic Effects: "CORTISOL"** - **C**entral obesity - **O**steoporosis (not osteosclerosis) - **R**ound facies - **T**hin skin, striae - **I**mmunosuppression - **S**ugar intolerance - **O**ver-mineralocorticoid (hypokalemia) - **L**ow bone density [cite:Harrison 21e Ch 375]
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