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Published in: Reviews in Endocrine and Metabolic Disorders 3/2016

01-09-2016

Skin manifestations of Cushing’s syndrome

Author: Constantine A. Stratakis

Published in: Reviews in Endocrine and Metabolic Disorders | Issue 3/2016

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Abstract

Among the most common diagnostic manifestations of Cushing’s syndrome (CS) are those involving the skin; they include violaceous striae, facial acne, hirsutism, acanthosis nigricans (AN), fungal infections, hyperpigmentation (Hp) and easy bruisability. Fortunately, most resolve within a year or two after cure of CS, although light-colored striae can persist for years depending on the age of the patients. AN, Hp, and bruisability usually resolve within months after cure in almost all ages. Facial plethora (along with acne and other facial skin changes) is a typical sign of CS that is due to increased perfusion. It resolves immediately after curative therapy of CS. Typically, the severity of the manifestations does not correlate with the biochemical indices of the disease, pointing to age, gender, genetic and skin-type differences that determine the cutaneous manifestations of CS.
Literature
1.
go back to reference Stratakis CA, Mastorakos G, Mitsiades NS, Mitsiades CS, Chrousos GP. Skin manifestations of Cushing disease in children and adolescents before and after the resolution of hypercortisolemia. Pediatr Dermatol. 1998;15(4):253–8.CrossRefPubMed Stratakis CA, Mastorakos G, Mitsiades NS, Mitsiades CS, Chrousos GP. Skin manifestations of Cushing disease in children and adolescents before and after the resolution of hypercortisolemia. Pediatr Dermatol. 1998;15(4):253–8.CrossRefPubMed
2.
go back to reference Lionakis MS, Kontoyiannis DP. Glucocorticoids and invasive fungal infections. Lancet. 2003;362(9398):1828–38.CrossRefPubMed Lionakis MS, Kontoyiannis DP. Glucocorticoids and invasive fungal infections. Lancet. 2003;362(9398):1828–38.CrossRefPubMed
3.
go back to reference Schoepe S, Schäcke H, May E, Asadullah K. Glucocorticoid therapy-induced skin atrophy. Exp Dermatol. 2006;15(6):406–20.CrossRefPubMed Schoepe S, Schäcke H, May E, Asadullah K. Glucocorticoid therapy-induced skin atrophy. Exp Dermatol. 2006;15(6):406–20.CrossRefPubMed
4.
5.
go back to reference Thiboutot DM. Dermatological manifestations of endocrine disorders. J Clin Endocrinol Metab. 1995;80(10):3082–7.PubMed Thiboutot DM. Dermatological manifestations of endocrine disorders. J Clin Endocrinol Metab. 1995;80(10):3082–7.PubMed
6.
7.
go back to reference Feingold KR, Elias PM. Endocrine-skin interactions: cutaneous manifestations of pituitary disease, thyroid disease, calcium disorders and diabetes. J Am Acad Dermatol. 1987;17:921–40.CrossRefPubMed Feingold KR, Elias PM. Endocrine-skin interactions: cutaneous manifestations of pituitary disease, thyroid disease, calcium disorders and diabetes. J Am Acad Dermatol. 1987;17:921–40.CrossRefPubMed
8.
go back to reference Gomez MT, Magiakou MA, Mastorakos G, Chrousos GP. The pituitary corticotroph is not the rate limiting step in the postoperative recovery of the hypothalamic-pituitary-adrenal axis in patients with Cushing syndrome. J Clin Endocrinol Metab. 1993;77(1):173–7.PubMed Gomez MT, Magiakou MA, Mastorakos G, Chrousos GP. The pituitary corticotroph is not the rate limiting step in the postoperative recovery of the hypothalamic-pituitary-adrenal axis in patients with Cushing syndrome. J Clin Endocrinol Metab. 1993;77(1):173–7.PubMed
9.
go back to reference Magiakou MA, Mastorakos GM, Gomez T, Rose SR, Chrousos GP. Suppressed spontaneous and stimulated growth hormone secretion in patients with Cushing’s disease. J Clin Endocrinol Metab. 1994;78(1):131–7.PubMed Magiakou MA, Mastorakos GM, Gomez T, Rose SR, Chrousos GP. Suppressed spontaneous and stimulated growth hormone secretion in patients with Cushing’s disease. J Clin Endocrinol Metab. 1994;78(1):131–7.PubMed
10.
go back to reference Stratakis CA. Cushing syndrome in pediatrics. Endocrinol Metab Clin N Am. 2012 Dec;41(4):793–803.CrossRef Stratakis CA. Cushing syndrome in pediatrics. Endocrinol Metab Clin N Am. 2012 Dec;41(4):793–803.CrossRef
11.
go back to reference Gourgari E, Lodish M, Keil M, Wesley R, Hill S, Xekouki P, Lyssikatos C, Belyavskaya E, De La Luz SM, Stratakis CA. Post-operative growth is different in various forms of pediatric Cushing’s syndrome. Endocr Relat Cancer. 2014;21(6):L27–31.CrossRefPubMedPubMedCentral Gourgari E, Lodish M, Keil M, Wesley R, Hill S, Xekouki P, Lyssikatos C, Belyavskaya E, De La Luz SM, Stratakis CA. Post-operative growth is different in various forms of pediatric Cushing’s syndrome. Endocr Relat Cancer. 2014;21(6):L27–31.CrossRefPubMedPubMedCentral
12.
go back to reference Lodish M, Dunn SV, Sinaii N, Keil MF, Stratakis CA. Recovery of the hypothalamic-pituitary-adrenal axis in children and adolescents after surgical cure of Cushing’s disease. J Clin Endocrinol Metab. 2012;97(5):1483–91.CrossRefPubMedPubMedCentral Lodish M, Dunn SV, Sinaii N, Keil MF, Stratakis CA. Recovery of the hypothalamic-pituitary-adrenal axis in children and adolescents after surgical cure of Cushing’s disease. J Clin Endocrinol Metab. 2012;97(5):1483–91.CrossRefPubMedPubMedCentral
13.
go back to reference Stratakis CA, Magiakou MA, Mastorakos G, Passaro M, Oldfield EH, Cutler GB, Chrousos GP. Thyroid function in children with Cushing disease before and after surgical cure. J Pediatr. 1997;131(6):905–9.CrossRefPubMed Stratakis CA, Magiakou MA, Mastorakos G, Passaro M, Oldfield EH, Cutler GB, Chrousos GP. Thyroid function in children with Cushing disease before and after surgical cure. J Pediatr. 1997;131(6):905–9.CrossRefPubMed
14.
go back to reference Lacroix A, Feelders RA, Stratakis CA, Nieman LK. Cushing’s syndrome. Lancet. 2015;386(9996):913–27.CrossRefPubMed Lacroix A, Feelders RA, Stratakis CA, Nieman LK. Cushing’s syndrome. Lancet. 2015;386(9996):913–27.CrossRefPubMed
15.
go back to reference Lodish MB, Gourgari E, Sinaii N, Hill S, Libuit L, Mastroyannis S, Keil M, Batista DL, Stratakis CA. Skeletal maturation in children with Cushing syndrome is not consistently delayed: the role of corticotropin, obesity, and steroid hormones, and the effect of surgical cure. J Pediatr. 2014;164(4):801–6.CrossRefPubMedPubMedCentral Lodish MB, Gourgari E, Sinaii N, Hill S, Libuit L, Mastroyannis S, Keil M, Batista DL, Stratakis CA. Skeletal maturation in children with Cushing syndrome is not consistently delayed: the role of corticotropin, obesity, and steroid hormones, and the effect of surgical cure. J Pediatr. 2014;164(4):801–6.CrossRefPubMedPubMedCentral
16.
go back to reference Keil MF, Graf J, Gokarn N, Stratakis CA. Anthropometric measures and fasting insulin levels in children before and after cure of Cushing syndrome. Clin Nutr. 2012;31(3):359–63.CrossRefPubMed Keil MF, Graf J, Gokarn N, Stratakis CA. Anthropometric measures and fasting insulin levels in children before and after cure of Cushing syndrome. Clin Nutr. 2012;31(3):359–63.CrossRefPubMed
17.
go back to reference Briassoulis G, Damjanovic S, Xekouki P, Lefebvre H, Stratakis CA. The glucocorticoid receptor and its expression in the anterior pituitary and the adrenal cortex: a source of variation in hypothalamic-pituitary-adrenal axis function; implications for pituitary and adrenal tumors. Endocr Pract. 2011;17(6):941–8.CrossRefPubMedPubMedCentral Briassoulis G, Damjanovic S, Xekouki P, Lefebvre H, Stratakis CA. The glucocorticoid receptor and its expression in the anterior pituitary and the adrenal cortex: a source of variation in hypothalamic-pituitary-adrenal axis function; implications for pituitary and adrenal tumors. Endocr Pract. 2011;17(6):941–8.CrossRefPubMedPubMedCentral
18.
go back to reference Batista DL, Oldfield EH, Keil MF, Stratakis CA. Postoperative testing to predict recurrent Cushing disease in children. J Clin Endocrinol Metab. 2009;94(8):2757–65.CrossRefPubMedPubMedCentral Batista DL, Oldfield EH, Keil MF, Stratakis CA. Postoperative testing to predict recurrent Cushing disease in children. J Clin Endocrinol Metab. 2009;94(8):2757–65.CrossRefPubMedPubMedCentral
19.
go back to reference Lodish MB, Hsiao HP, Serbis A, Sinaii N, Rothenbuhler A, Keil MF, Boikos SA, Reynolds JC, Stratakis CA. Effects of Cushing disease on bone mineral density in a pediatric population. J Pediatr. 2010;156(6):1001–5.CrossRefPubMedPubMedCentral Lodish MB, Hsiao HP, Serbis A, Sinaii N, Rothenbuhler A, Keil MF, Boikos SA, Reynolds JC, Stratakis CA. Effects of Cushing disease on bone mineral density in a pediatric population. J Pediatr. 2010;156(6):1001–5.CrossRefPubMedPubMedCentral
20.
go back to reference Keil MF, Merke DP, Gandhi R, Wiggs EA, Obunse K, Stratakis CA. Quality of life in children and adolescents 1-year after cure of Cushing syndrome: a prospective study. Clin Endocrinol. 2009;71(3):326–33.CrossRef Keil MF, Merke DP, Gandhi R, Wiggs EA, Obunse K, Stratakis CA. Quality of life in children and adolescents 1-year after cure of Cushing syndrome: a prospective study. Clin Endocrinol. 2009;71(3):326–33.CrossRef
21.
go back to reference Michelson D, Stratakis CA, Hill L, Reynolds J, et al. Bone mineral density in women with depression. N Engl J Med. 1996;335:1176–81.CrossRefPubMed Michelson D, Stratakis CA, Hill L, Reynolds J, et al. Bone mineral density in women with depression. N Engl J Med. 1996;335:1176–81.CrossRefPubMed
23.
go back to reference Serres M, Viac J, Schmitt DB. Glucocorticoid receptor localization in human epidermal cells. Arch Dermatol Res. 1996;288:140–6.CrossRefPubMed Serres M, Viac J, Schmitt DB. Glucocorticoid receptor localization in human epidermal cells. Arch Dermatol Res. 1996;288:140–6.CrossRefPubMed
24.
go back to reference Chedid M, Hoyle JR, Csaky KG, Rubin JS. Glucocorticoids inhibit keratinocyte growth factor production in primary dermal fibroblasts. Endocrinology. 1996;137:2232–7.PubMed Chedid M, Hoyle JR, Csaky KG, Rubin JS. Glucocorticoids inhibit keratinocyte growth factor production in primary dermal fibroblasts. Endocrinology. 1996;137:2232–7.PubMed
25.
go back to reference Meisler N, Shull S, Xie R, Long GL, Asher M, Connoly JP, Cutroneo KR. Glucocorticoids coordinately regulate type I collagen pro-alpha 1 promoter activity thorugh both the glucocorticoid and TGF-b response elements: a novel mechanism of glucococrtocid regulation of eukaryotic genes. J Cell Biochem. 1995;59:376–88.CrossRefPubMed Meisler N, Shull S, Xie R, Long GL, Asher M, Connoly JP, Cutroneo KR. Glucocorticoids coordinately regulate type I collagen pro-alpha 1 promoter activity thorugh both the glucocorticoid and TGF-b response elements: a novel mechanism of glucococrtocid regulation of eukaryotic genes. J Cell Biochem. 1995;59:376–88.CrossRefPubMed
26.
go back to reference Brauchle M, Fassler R, Werner S. Suppression of keratinocyte growth factor expression by glucocorticoids in vitro and during wound healing. J Invest Dermatol. 1995;105:579–84.CrossRefPubMed Brauchle M, Fassler R, Werner S. Suppression of keratinocyte growth factor expression by glucocorticoids in vitro and during wound healing. J Invest Dermatol. 1995;105:579–84.CrossRefPubMed
27.
go back to reference Haapasaari KM, Risteli J, Oikarinen A. Recovery of human skin collagen synthesis after short-term topical corticosteroid treatment and comparison between young and old subjects. J Dermatol. 1996;135:65–9.CrossRef Haapasaari KM, Risteli J, Oikarinen A. Recovery of human skin collagen synthesis after short-term topical corticosteroid treatment and comparison between young and old subjects. J Dermatol. 1996;135:65–9.CrossRef
28.
go back to reference McMichael AJ, Griffiths CE, Talwar HS, Finkel LJ, Rafal ES, Hamilton TA, Voorhees JJ. Concurrent application of tretinoin (retinoic acid) partially protects against corticosteroid-induced epidermal atrophy. Br J Dermatol. 1996;135:60–4.CrossRefPubMed McMichael AJ, Griffiths CE, Talwar HS, Finkel LJ, Rafal ES, Hamilton TA, Voorhees JJ. Concurrent application of tretinoin (retinoic acid) partially protects against corticosteroid-induced epidermal atrophy. Br J Dermatol. 1996;135:60–4.CrossRefPubMed
29.
go back to reference Nesbitt Jr LT. Minimizing complications from systemic glucocorticoid use. Dermatol Clin. 1995;13:925–39.PubMed Nesbitt Jr LT. Minimizing complications from systemic glucocorticoid use. Dermatol Clin. 1995;13:925–39.PubMed
30.
go back to reference Bouzas EA, Mastorakos G, Friedman TC, Scott MH, Chrousos GP, Kaiser-Kupfer MI. Posterior subcapsular cataract in endogenous Cushing syndrome: an uncommon manifestation. Invest Ophthalmol Vis Sci. 1993;34:3497–500.PubMed Bouzas EA, Mastorakos G, Friedman TC, Scott MH, Chrousos GP, Kaiser-Kupfer MI. Posterior subcapsular cataract in endogenous Cushing syndrome: an uncommon manifestation. Invest Ophthalmol Vis Sci. 1993;34:3497–500.PubMed
31.
go back to reference Afshari A, Ardeshirpour Y, Lodish MB, Gourgari E, Sinaii N, Keil M, Belyavskaya E, Lyssikatos C, Chowdhry FA, Chernomordik V, Anderson AA, Mazzuchi TA, Gandjbakhche A, Stratakis CA. Facial plethora: modern technology for quantifying an ancient clinical sign and its use in Cushing syndrome. J Clin Endocrinol Metab. 2015;100(10):3928–33. Afshari A, Ardeshirpour Y, Lodish MB, Gourgari E, Sinaii N, Keil M, Belyavskaya E, Lyssikatos C, Chowdhry FA, Chernomordik V, Anderson AA, Mazzuchi TA, Gandjbakhche A, Stratakis CA. Facial plethora: modern technology for quantifying an ancient clinical sign and its use in Cushing syndrome. J Clin Endocrinol Metab. 2015;100(10):3928–33.
Metadata
Title
Skin manifestations of Cushing’s syndrome
Author
Constantine A. Stratakis
Publication date
01-09-2016
Publisher
Springer US
Published in
Reviews in Endocrine and Metabolic Disorders / Issue 3/2016
Print ISSN: 1389-9155
Electronic ISSN: 1573-2606
DOI
https://doi.org/10.1007/s11154-016-9399-3

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