Reverse Stretch Marks
Stretch Marks Prevention and Treatment. Learn What Exactly Are Stretch Marks And How Can They Be Treated. MP3 Audio included for your PC or IPod.
A review of 31 patients with Cushing's disease showed that the commonest clinical features, in order of frequency, were weakness, thin skin, obesity, easy bruising, hypertension, menstrual disorders, hirsutism, impotence, striae, proximal muscle weakness, oedema, osteoporosis, mental disorders, diabetic GTT, backache, acne, hypokalaemia and fasting hyperglycaemia (Urbanic & George 1981). Fractures occur, and wound healing is poor.
If the degree of androgenization is severe, resulting in clitoromegaly, severe male-pattern balding, and masculinization of the body (decrease in breast size, increase in muscle mass, loss of hip-to-waist discordance, etc.), an androgenic tumor or syndrome of severe insulin resistance (i.e., HAIR-AN syndrome) should be suspected. The presence of cushingoid features (i.e., centripetal obesity, muscle wasting of the extremities, moon facies, generalized facial rubor, or purple-red abdominal striae) in association with hirsutism is particularly worrisome, because it suggests the possibility of either an adrenocortical carcinoma or ACTH excess resulting from an ectopic or pituitary ACTH-producing tumor. The presence of acanthosis nigricans signals significant hyperinsulinism, observable in very insulin-resistant women with PCOS or in patients with the HAIR-AN syndrome.
Anovulation Is A Characteristic Feature Of Pcos. It Manifests As Menstrual Disturbance 80 Amenorrhoea Oligoamenorrhea
Weight gain that is primarily centripetal, especially if associated with extremity wasting, purple striae, easy bruisability, moon facies, and rubor, suggests the presence of Cushing's syndrome, and these patients should be appropriately screened using 24-hour urinary-free cortisol levels or a cortisol level following an overnight dexamethasone suppression test. Other information that should be sought includes the patient's awareness of her body fat distribution, as women with PCOS have a greater prevalence of abdominal obesity (29). Weight gain may also be associated with carbohydrate craving and evidence of postprandial reactive hypoglycemia, particularly in mid-afternoons. For example, Holte and colleagues found that although insulin resistance in obese women with PCOS was reduced by weight loss to similar levels as BMI-matched controls, these patients continued to demonstrate an increased early insulin response to glucose, which could stimulate appetite and persistent weight gain...
At puberty, androgens stimulate development of body hair and apocrine glands and increased sebaceous secretion estrogens stimulate fat deposition and breast development in females pregnancy may cause pigmentation changes and stretch marks Sensory stimulation of skin important to sexual arousal mammary glands nourish infant
May be unrecognized when patients are being treated in rheumatology, psychiatry, and orthopedic clinics. Progressive central weight gain (truncal obesity) is the most universal symptom of patients with Cushing's syndrome. Certain features, such as proximal muscle weakness and purple striae wider than 1 cm, are reliable clues to the diagnosis (Figure 11 2).16,17 Particular attention should be paid to worsening of signs or symptoms over time and findings atypical for age, such as thinning skin in young men or osteoporosis in children. The hallmark of Cushing's syndrome in a child is growth failure, and timely diagnosis is important to ensure normal growth and puberty.218-20 Certain clinical and biochemical features may suggest a specific cause of Cushing's syndrome (Table 11 2).8,10,21-24
Physical characteristics of Cushing's syndrome. A, Side profile of a patient with Cushing's syndrome demonstrating an increased cervical fat pad (so-called buffalo hump), abdominal obesity, and thin extremities and petechiae (on the wrist). The round (so-called moon) facial appearance, plethora, and acne cannot be seen readily here. B, Violescent abdominal striae in a patient with Cushing's syndrome. Such striae also can be observed on the inner parts of the legs in some patients.