Distinctive physical changes deserve a targeted endocrine review

Progressive easy bruising, wide purple striae and proximal weakness can raise suspicion for cortisol excess when interpreted together.

Endogenous Cushing syndromeLoss of normal cortisol regulation may cause progressive characteristic features.
Exogenous glucocorticoid exposurePrescribed or topical steroids can cause Cushingoid changes and adrenal suppression.
Metabolic syndrome or insulin resistanceWeight gain and blood-pressure change can arise without pathologic cortisol excess.
Sleep disturbance and chronic stress physiologyPoor sleep can affect weight and cortisol rhythms but is not equivalent to Cushing syndrome.
Thyroid or other endocrine causeHormonal changes can overlap in appearance and symptoms.

Weight gain alone does not establish cortisol excess

Central weight gain and insomnia have many causes; indiscriminate cortisol testing often produces confusing results.

Exogenous glucocorticoid exposurePrescribed or topical steroids can cause Cushingoid changes and adrenal suppression.
Metabolic syndrome or insulin resistanceWeight gain and blood-pressure change can arise without pathologic cortisol excess.
Sleep disturbance and chronic stress physiologyPoor sleep can affect weight and cortisol rhythms but is not equivalent to Cushing syndrome.
Thyroid or other endocrine causeHormonal changes can overlap in appearance and symptoms.
Endogenous Cushing syndromeLoss of normal cortisol regulation may cause progressive characteristic features.

Steroids from tablets, injections, inhalers or creams may have systemic effects depending on exposure.

Metabolic syndrome or insulin resistanceWeight gain and blood-pressure change can arise without pathologic cortisol excess.
Sleep disturbance and chronic stress physiologyPoor sleep can affect weight and cortisol rhythms but is not equivalent to Cushing syndrome.
Thyroid or other endocrine causeHormonal changes can overlap in appearance and symptoms.
Endogenous Cushing syndromeLoss of normal cortisol regulation may cause progressive characteristic features.
Exogenous glucocorticoid exposurePrescribed or topical steroids can cause Cushingoid changes and adrenal suppression.

Cortisol varies across the day, so a morning result cannot rule out endogenous Cushing syndrome.

Sleep disturbance and chronic stress physiologyPoor sleep can affect weight and cortisol rhythms but is not equivalent to Cushing syndrome.
Thyroid or other endocrine causeHormonal changes can overlap in appearance and symptoms.
Endogenous Cushing syndromeLoss of normal cortisol regulation may cause progressive characteristic features.
Exogenous glucocorticoid exposurePrescribed or topical steroids can cause Cushingoid changes and adrenal suppression.
Metabolic syndrome or insulin resistanceWeight gain and blood-pressure change can arise without pathologic cortisol excess.