The most common cause of Cushing syndrome is the use of exogenous glucocorticoids, and it is rarer to have a problem with the hypothalamic-pituitary-adrenal axis.
These patients can present with:
proximal muscle weakness
easy bruising
weight gain
hypertension
diabetes
impaired immune function
infertility or menstrual irregularities
For the emergency department we need to be worried about those on chronic steroids that can not increase their native steroid production in a time of stress which will lead them to adrenal crisis.
Pearls for those with Cushing Syndrome:
May have perforated viscous with minimal peritoneal signs
Suspectable to fungal infections so consider adding fluconazole to those that are septic
Give a large dose of hydrocortisone 100mg PO/IV every 8 hours if you suspect adrenal crisis.
