Read this section with one caveat: the classic phenotype is variable, not universal. Mild, early, cyclical, and rapidly progressive ectopic disease may show few or none of these features, and many patients presenting with them do not have Cushing syndrome at all. Absence of a moon face or striae does not exclude the diagnosis. Features that best discriminate Cushing syndrome from simple obesity — these are the ones worth weighting: - Proximal muscle weakness — difficulty rising from a chair or climbing stairs without using the arms; assess it directly rather than asking - Wide (>1 cm) violaceous striae, typically abdominal, and clearly distinct from the narrow pale striae of weight change - Easy bruising and skin fragility with no adequate trauma; thin, translucent skin and poor wound healing - Facial plethora - Unexplained osteoporosis or fragility fracture in a younger patient Less discriminating but commonly present: central adiposity with relatively thin limbs, dorsocervical and supraclavicular fat pads, rounded facies, weight gain, hypertension, hyperglycemia, hirsutism and acne, menstrual irregularity, reduced libido, and peripheral oedema. Psychological and cognitive change is frequently...