A patient present with hyperpigmentation moon face and truncal obesity the most likely hormonal abnormality is increased Cortisol ACTH
Reading File
Searching for the hormonal basis of Cushing's syndrome features including hyperpigmentation, moon face, and truncal obesity.
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Cushing syndrome hyperpigmentation moon face truncal obesity cortisol ACTH hormonal abnormality
Bailey and Love's Short Practice of Surgery 28th Edition
Page 914
GradeResponse
The answer is Cortisol.
Here is the reasoning:
Answer: Increased Cortisol
The clinical triad described — hyperpigmentation, moon face, and truncal obesity — is classic for Cushing's syndrome, which results from chronically elevated cortisol.
Why Cortisol, Not ACTH?
| Feature | Caused by |
|---|---|
| Moon face (facial rounding/plethora) | ↑ Cortisol |
| Truncal (central) obesity / "lemon on sticks" | ↑ Cortisol |
| Buffalo hump | ↑ Cortisol |
| Hypertension, diabetes, proximal myopathy | ↑ Cortisol |
| Hyperpigmentation | ↑ ACTH (not cortisol itself) |
The Key Distinction — Hyperpigmentation
Hyperpigmentation is caused by excess ACTH (and its precursor POMC/MSH), not by cortisol directly. However, the primary and unifying hormonal abnormality across all forms of Cushing's syndrome is elevated cortisol.
- In ACTH-dependent Cushing's (e.g., pituitary adenoma — Cushing's disease, or ectopic ACTH syndrome), both ACTH and cortisol are elevated. Hyperpigmentation is especially prominent in ectopic ACTH syndrome due to very high ACTH levels.
- In ACTH-independent Cushing's (adrenal adenoma/carcinoma), cortisol is elevated but ACTH is suppressed — and hyperpigmentation is absent.
For Exam Purposes
The question asks for the most likely hormonal abnormality. Since all three features together (moon face + truncal obesity + hyperpigmentation) point specifically to ACTH-dependent Cushing's syndrome, the complete answer is:
Both cortisol AND ACTH are elevated, but if forced to choose one overarching abnormality — increased Cortisol is the primary driver of the syndrome, while hyperpigmentation specifically signals elevated ACTH.
(Bailey & Love's Surgery, 28th Ed., p. 914)
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