List typical signs of Cushing syndrome.

• A. Central obesity, moon face, dorsocervical fat pad (buffalo hump), abdominal striae, hypertension, glucose intolerance
• B. Hyperpigmented rash on extremities
• C. Weight loss with tremors
• D. Jaundice with pruritus

Answer: (A)

Excess cortisol drives fat redistribution and metabolic changes, producing a recognizable cluster of signs in Cushing syndrome. Cortisol promotes fat storage in the trunk and face while thinning the skin, which leads to central obesity, a round “moon” face, and a dorsocervical fat pad (buffalo hump). It also weakens collagen and skin structure, causing abdominal striae. Metabolic effects include insulin resistance, which contributes to glucose intolerance, and water/salt retention with higher blood pressure, leading to hypertension. Taken together, these features form a classic presentation of cortisol excess.

The other descriptions don’t fit Cushing syndrome’s typical pattern. A hyperpigmented rash on the extremities is more in line with conditions involving increased ACTH or pigmentary changes seen in Addison disease. Weight loss with tremors points toward hyperthyroidism or other metabolic disorders, not cortisol excess. Jaundice with pruritus suggests liver disease or biliary problems, not Cushing syndrome.