Which symptom would best indicate Cushing's syndrome in a patient with suspected hypercortisolism?

• A. Weight gain with truncal obesity
• B. Weight loss with muscle wasting
• C. Hypokalemia
• D. Hypoglycemia

Answer: (A)

Prolonged exposure to cortisol causes fat to be redistributed to the trunk and face, leading to central obesity. This change—weight gain with truncal obesity—is the most characteristic and readily observed clue of Cushing’s syndrome, making it the best indicator when hypercortisolism is suspected.

Other signs can occur with excess cortisol—muscle wasting can happen due to protein breakdown, and a mineralocorticoid-like effect can cause shifts in potassium in some patients—but these are less specific. Cortisol tends to raise blood glucose (hyperglycemia) rather than cause hypoglycemia, so that option is not typical of Cushing’s.