<prompt> Most important features in cushing syndrome isCentripetal obesityHypertensionMenorrhagiaPolyurea  <response>: Centripetal obesity 1050- CMDT-10, 2252-2255-H17thCUSHING SYNDROME HYPERCORTISOLISMESSENTIALS OF DIAGNOSIS Central obesity, with a plethoric moon face buffalo hump supraclavicular fat pad, protuberant abdomen, thin extremities, muscle wasting, thin, skin, purple striae, Hirsutism Psychological changes - frank psychosis Olegomenorrhagia or amenorrhea or impotence in male Osteoporosis, hypertension, poor wound healing, polyurea, renal calculi, glaucoma Hyperglycemia, glycosuria, leukocytosis, lymphocytopenia hypokalemia Elevated serum cortisol and urinary free cortisol, Lack of normal suppression by dexamethasone Hypertension is seen in cushing syndrome because of sodium and water retension so it is sustained hypertension Not episodicInterestingly, hypercortisolism without cushing syndrome can occur in - severe depression, anorexia nervosa, alcoholism and familial cortisol resistance, familial lipodystrophy type I patients receiving anti retroviral therapy for HIV-I infection Earliest manifestation of cushings syndrome is - Loss of diurmal variation Cushings disease is associated with increased ACTH and increased cortisol Conns syndrome is most commonly associated with cortical adenoma NELSON SYNDROME - is a disorder characterized by rapid growth of ACTH secreting pituitary adenoma following bilateral adrenalectomy which was performed for cushing disease Most common cause of Cushings syndrome is iatrogenic administration of steroidsFrequency of sign symptoms of cushing syndrome Typical habitus centripetal obesity97 Personality changes66 Increased body weight94 Ecchymosis65 Fatigability and weakness87 Proximal myopathy 62 Hypertension BP 1509082 Edema62 Hirsutism80 Polyurea polydipsia23 Amenorrhea77 Hypertrophy of clitoris19 Broad violaceous cutaneous striae67 