All are features of Cushing's disease except: (AIIMS Nov 2011)
Features of Cushing’s syndrome
1). Symptoms due to excess of glucocorticoid
a. The loss of proteins from the muscle in particular causes severe weakness of proximal muscles (Proximal myopathy)
b. The protein collagen fibres in the subcutaneous tissue are diminished so that the subcutaneous tissue tear easily resulting in development of large purplish striae where they have torn apart.
c. Elevated blood glucose concentration. Insulin resistance can occur
d. Mobilization of fat from the lower part of the body with concomitant extra deposition of fat in the thoracic and upper abdominal regions (Centripetal obesity) giving rise to a buffalo torso. The excess secretion of steroid also leads to an edematous appearance of the face. ("moon facies").
2). Symptoms due to excess of mineralocorticoid
a. Salt and water retention leads to sustained hypertension.
b. Significant K+ depletion (Hypokalemia)
Note: Episodic hypertension occurs in pheochromocytoma
3). Symptoms due to excess of androgen
b. Facial acne
4). Other Symptoms
a. Psychosis, insomnia, euphoria