Thin Skin in Cushing’s Syndrome

This Images in Clinical Medicine report features a 53-year-old woman with metastatic small-cell lung cancer who presented with signs consistent with Cushing’s syndrome hypertension, hypokalemia, hyperglycemia, and metabolic alkalosis. Focused examination using skin calipers showed significantly reduced skin thickness on the back of the third finger (1.2 mm vs. normal >1.8 mm), indicating the antianabolic effects of elevated cortisol. Diagnostic confirmation included elevated cortisol and corticotropin levels, alongside imaging that revealed widespread metastases. The syndrome was attributed to paraneoplastic hypercortisolism. Given the poor prognosis, the patient chose palliative care and passed away within a week. The case highlights a practical diagnostic marker—finger skin thickness for assessing hypercortisolism.

This Images in Clinical Medicine report features a 53-year-old woman with metastatic small-cell lung cancer who presented with signs consistent with Cushing’s syndrome hypertension, hypokalemia, hyperglycemia, and metabolic alkalosis. Focused examination using skin calipers showed significantly reduced skin thickness on the back of the third finger (1.2 mm vs. normal >1.8 mm), indicating the antianabolic effects of elevated cortisol. Diagnostic confirmation included elevated cortisol and corticotropin levels, alongside imaging that revealed widespread metastases. The syndrome was attributed to paraneoplastic hypercortisolism. Given the poor prognosis, the patient chose palliative care and passed away within a week. The case highlights a practical diagnostic marker—finger skin thickness for assessing hypercortisolism.