A patient present with hyperpigmentation moon face and truncal obesity the most likely hormonal abnormality is increased Cortisol ACTH
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Cushing syndrome hyperpigmentation moon face truncal obesity cortisol ACTH hormonal abnormality
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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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