Introduction: Diaphoresis, or excessive sweating, is well recognised as a presenting complaint for endocrine disorders such as hyperthyroidism, acromegaly, and phaeochromocytoma. However, diaphoresis is an unusual presenting complaint for Cushings syndrome.
Case: We present the case of a 35-year-old lady who first presented to health services for symptoms of excessive sweating, and feeling hot most of the time. Whilst initial investigations such as thyroid hormone measurement did not reveal a cause, she subsequently developed classical symptoms of Cushings syndrome including weight gain with increased central adiposity and a noticeable change in her facial appearance. She also developed hirsutism and proximal myopathy in her legs. She was diagnosed with hypertension 2 years after her initial presentation, and developed easy bruising and thinning of the skin. A low dose dexamethasone suppression test was consistent with pituitary dependent Cushings syndrome, with an ACTH of 46ng/l and cortisol of 780 nmol/l at baseline, which did not suppress with a cortisol level of 136 nmol/l at 48 h. Inferior petrosal sinus sampling confirmed a pituitary source of ACTH secretion and a pituitary MRI scan identified a low signal lesion in the antero-inferior aspect of the gland thus surgical removal was instigated.
Discussion: Whilst diaphoresis is a common symptom of several endocrine disorders, it is an uncommon presenting complaint for Cushings syndrome. In this case, the patient was not investigated for the Cushings syndrome until other more classical symptoms arose almost 2 years later. Diaphoresis is a recognised, but uncommon symptom in the presentation of Cushings syndrome. Patients presenting with diaphoresis should prompt evaluation for more classical features of Cushings syndrome.