This document summarizes the physical exam findings that suggest Cushing's disease. When lying down, signs on the face include a moon face, hirsutism, acne, plethora from telangiectasia, and oral thrush. The shoulders may show supraclavicular fat pads and the abdomen may be obese with thin skin, purple striae, and bruising and wasting of the limbs. When standing up, the shoulders may have an interscapular buffalo hump and the spine may show kyphoscoliosis, vertebral fractures or osteoporosis. Long-term steroid use can cause similar findings and systemic exams include checking the urine for glucose, visual fields for pituitary tumors, and

1. Short Case Approach to Cushing’s disease
Lying down
Face
1. Moon-like facies
2. Hirsutism
3. Acne
4. Plethora due to telangiectasia
5. Mouth for oral thrush
Shoulders
1. Supraclavicular fat pads
Abdomen
1. Truncal obesity
2. Thinning of skin
3. Purple striae
Limbs
1. Bruising
2. Wasting
Standing up
Shoulders
1. Interscapular Buffalo hump
Spine
1. Kyphoscoliosis
2. Vertebral collapse/ fracture / osteoporosis
Limbs
1. Proximal myopathy
Signs of conditions requiring long term steroid therapy
1. Asthma
2. RA
3. SLE
4. Fibrosing alveolitis
Systemic
1. Urine for glucose
2. Visual field for Pituitary tumour
3. Fundus for optic atrophy, papilloedema, signs of HPT or diabetic retinopathy
Digitally signed by DR WANA HLA SHWE
DN: cn=DR WANA HLA SHWE, c=MY,
o=UCSI University, School of Medicine, KT-
Campus, Terengganu, ou=Internal Medicine
Group, email=wunna.hlashwe@gmail.com
Reason: This document is for UCSI year 4
students.
Date: 2009.02.24 13:57:37 +08'00'