The nurse is assessing a client with Cushing’s Syndrome. Which physical characteristic is expected?

Cushing's Syndrome results from prolonged elevated cortisol levels, which produce a distinctive constellation of physical findings. Excess cortisol promotes redistribution of adipose tissue to central locations, resulting in truncal obesity and a dorsocervical fat pad called the 'buffalo hump,' as well as a rounded 'moon face.' These redistributive fat changes are hallmarks of the syndrome and are the expected physical characteristics a nurse would assess. Extreme weight loss is incorrect because Cushing's Syndrome causes weight gain rather than loss due to cortisol's lipogenic and gluconeogenic effects. Hyperpigmentation of the skin is characteristic of Addison's disease, the opposite condition, where low cortisol causes compensatory elevation of ACTH, which stimulates melanocyte production — this does not occur in Cushing's Syndrome where cortisol is already elevated. Low blood pressure is also associated with Addison's disease; in Cushing's Syndrome, cortisol's mineralocorticoid activity causes sodium and water retention, leading to hypertension rather than hypotension. Students should remember that the key distinguishing features of Cushing's Syndrome are the product of cortisol excess: central fat redistribution, hypertension, hyperglycemia, muscle wasting in the extremities, and skin changes such as purple striae — not hyperpigmentation.