Mild CS (termed subclinical or occult) is more common than previously thought and has been identified while investigating for diabetes, osteoporosis, hypertension or neuropsychological disturbances. Other less specific features include fatigue, high blood pressure, glucose intolerance, hypokalemia, acne, hirsutism, menstrual irregularity, diminished libido, erectile dysfunction, neuropsychological disturbances (including depression, emotional irritability, sleep disturbances, cognitive deficits), increased susceptibility to infections and urolithiasis. Typical clinical features are truncal and facial obesity, signs of hypercatabolism (thinned skin, purple striae, ecchymosis, bruising with no obvious trauma, proximal muscle weakness with amyotrophy, unexplained osteoporosis) and, in children, weight gain with decreasing growth velocity. Prevalence of endogenous CS is 1/26,000 and, in the EU, it has an annual incidence of 1/1,400,000-1/400,000, with a peak incidence at 25-40 years of age.
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