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Endogenous: Pituitary adenoma secreting ACTH secondary adrenal hyperplasia Adrenal adenoma or carcinoma cortisol overproduction Ectopic ACTH secretion (e.g., small cell lung cancer) Clinical Features: Weight gain with central obesity Moon face Buffalo hump (fat pad on upper back) Thin limbs and muscle wasting Skin changes: purple striae, easy bruising, acne, hirsutism Hypertension, glucose intolerance Osteoporosis, menstrual irregularities Diagnosis: Elevated 24-hour urinary free cortisol Dexamethasone suppression test Imaging to locate source Treatment: Depends on cause: discontinue steroids, surgical removal of tumors, or medications to inhibit cortisol Cushing Disease Definition: Specific cause of Cushing syndrome due to excess ACTH production by a pituitary adenoma