Which combination of signs is classic for Cushing syndrome?

• A. Weight loss, hypotension, hyperpigmentation, tachycardia
• B. Edema, bradycardia, hypokalemia
• C. Hypoactivity, weight loss
• D. Central obesity, moon facies, buffalo hump, purple abdominal striae, hypertension, and hyperglycemia

Answer: (D)

Excess cortisol produces a telltale pattern of fat distribution and metabolic effects. The classic presentation includes central obesity with a rounded moon-like face, a dorsocervical fat pad (buffalo hump), and thinning skin with purple (violaceous) abdominal striae. Cortisol also drives hypertension and hyperglycemia by promoting gluconeogenesis, insulin resistance, and fluid retention. This cluster—central obesity, moon facies, buffalo hump, purple abdominal striae, hypertension, and hyperglycemia—best fits Cushing syndrome.

Patterns like weight loss with hypotension point toward Addison’s disease, while edema with bradycardia or hypokalemia is not the typical Cushing picture, and hypoactivity with weight loss suggests other conditions.