- ACTH dependent: pituitary tumor, small cell lung cancer (ectopic ACTH production)
- ACTH independent (Cushing's Disease): Adrenal tumor
- Exogenous steroid consumption
- Central wt gain→ neck/face/thorax/abd
- Glucose intolerance/dm
- Proximal muscle weakness
- Unexplained osteoporosis
- If ACTH dependent from pituitary tumor→ headache, visual field cuts, other pituitary hormone related symptoms; if from SCLC→ SOB, cough, etc
- Purple/red striae
- Posterior cervical (buffalo hump) and supraclavicular fat pads
- Hyperpigmentation in mouth/sun exposed areas if ACTH dependent
- Need 2 positive tests: 24 hour urine cortisol, midnight salivary cortisol, low dose dex suppression
- Once elevated cortisol documented, check ACTH