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A Useful Measurement for Distinguishing Cushing's Disease From Other Causes of Hirsutism and Oligomenorrhea

Bernard Corenblum, MD, FRCPC; Terry Kwan; Shirl Gee; Norman C. W. Wong, MD, FRCPC

Arch Intern Med. 1994;154(7):777-781.

Abstract
Background
The known catabolic effects of glucocorticoid excess on protein metabolism prompted us to devise a method to assess this measure in reproductiveaged females with Cushing's disease. Since collagen protein is a major component of skin, decreased abundance of this protein should cause a reduction in skin-fold thickness. To determine whether skin-fold thickness is useful as an added tool in the diagnosis of Cushing's disease, we compared this value in female patients with Cushing's disease with those who presented with a similar set of symptoms.

Methods
This open prospective study was conducted in an endocrinology clinic at a tertiary care center. The study population consisted of 88 females in the reproductive age group who presented to the clinic with hirsutism, oligomenorrhea, and/or obesity. Measurement of skin-fold thickness, body mass index, Ferriman-Gallwey index, and serum testosterone were performed in all patients.

Results
Skin-fold thickness in the patients with Cushing's disease was 1.5±0.2 mm (range, 1.0 to 1.8 mm). This value was significantly (P<.01) lower than that in controls or subjects with other disorders that have a similar set of presenting symptoms.

Conclusions
Bedside assessment of skin-fold thickness is an easy, low-cost, and noninvasive test for distinguishing Cushing's disease from disorders with similar presenting symptoms in females of reproductive age. Assessment of skin-fold thickness should be used as an adjunct to current physical and biochemical study of patients with symptoms suggestive of Cushing's disease.

(Arch Intern Med. 1994;154:777-781)

Author Affiliations
From the Division of Endocrinology and Metabolism, Department of Medicine (Drs Corenblum and Wong), and Department of Medical Biochemistry (Dr Wong), University of Calgary (Alberta). Mss Kwan and Gee are second-year medical students at the University of Alberta, Edmonton.

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