Need for Screening & Epidemiology Who should be screened for Cushing syndrome? 1) Anyone who has signs and symptoms consistent with too much cortisol (Hypercortisolism), especially when multiple signs and symptoms are present in the same patient. Symptoms • Weight gain with central obesity (meaning unusual fat deposition around your abdomen) • Facial rounding and plethora (called moon face) • Supraclavicular and dorsocervical fat pads (fat deposits on the back; “buffalo hump”) • Easy bruising, thin skin • Poor wound healing • Purple striae (stretch marks, especially on the lower abdomen and upper thighs) • Proximal muscle weakness • Emotional and neurocognitive changes (Variable, but may be anxiety, depression, memory problems, etc.) • Opportunistic and fungal infections • Acne • Hirsutism (excessive facial hair • Signs • Hypertension • Osteopenia • Osteoporosis • Fasting hyperglycemia • Diabetes mellitus • Hypokalemia • Hyperlipidemia (High blood lipids; fat) • Leukocytosis (High white blood count) 2) Patients with multiple and especially progressive features (symptoms are worsening), highly suggestive of the Cushing’s syndrome 3) Patients with adrenocortical incidentalomas 4) Young patients (< 50 years old) with unusual features for their age (e.g., hypertension, osteoporosis, etc) 5) Children with decreasing height percentile and increasing weight