A 40 year old male presents to the clinic with hypertension of recent onset

A 40 year old male presents to the clinic with hypertension of recent onset. He reports weight gain and irritability. On examination, it is noted that he is obese, has a plethoric appearance and there are purplish striae over the abdomen and multiple bruises on both lower legs. His blood pressure is 162/96. He reports that he has a history of rhinitis, allergies and eczema and he has been incorrectly over-using his fluticasone nasal spray, and his Flovent inhaler. He also reports that he has been liberally applying betamethasone ointment to his irritated skin areas. You suspect that he may have Cushing’s syndrome. What is the pathophysiological cause of his Cushing syndrome? What would you expect to find if you drew a cortisol level? How can you safely decrease his steroid use?

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