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Skin manifestations in Cushing's syndrome: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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Cushing's syndrome (synonym: Itenko-Cushing syndrome).
Causes and pathogenesis of Cushing's syndrome. Cushing's syndrome occurs with an increase in blood glucocorticoids. Endogenous Cushing's syndrome is due to the excessive production of cortisol by the adrenal cortex. Excess production of ACTH is observed under 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) Cushing syndrome occurs with long-term treatment (in a transdermal, inward or local) corticosteroid 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 changes in character. With an external examination, obesity, redistribution of fatty deposits (face, body, abdomen, suprapatric region), a full-face moonlike face, a fatty hump on the neck, a thick trunk and thin limbs can be seen. There is a noticeable atrophy of the skin: thinning (atrophy of the epidermis and dermis); ecchymosis with the slightest trauma, telangiectasia (a full-blooded face). There is an increased growth of terminal hair on the face and often - gun hair on the lycée (hypertrichosis), in women - hirsutism and androgenic alopecia. Often there are steroid acne: monomorphic eruptions, which differ from ordinary acne with an almost complete absence of comedones. In places there are hyperpigmentation due to increased production of ACTH. In patients with Cushing's syndrome, fungal (varicoloured dermatophytes) and viral infections are common. Of the concomitant diseases, there are arterial hypertension, mental disorders, myopathy, gastrointestinal tract diseases, osteoporosis, etc.
Differential diagnosis. Cushing's syndrome should be distinguished from obesity, depression.
Treatment of Cushing's syndrome. It is necessary to identify and eliminate the causes of the disease.
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