MBBS OSCE · Endocrinology
OSCE — Cushing Syndrome
Eight-minute OSCE station on Cushing Syndrome: focused history, examination priorities, investigations, emergency and definitive management.
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Brief (to candidate)
You will assess a patient with a presentation consistent with Cushing Syndrome.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Cushing syndrome is the clinical and biochemical syndrome resulting from chronic exposure to excess glucocorticoid (endogenous cortisol or exogenous steroid). Exogenous (iatrogenic) steroid therapy is the commonest cause overall; of endogenous causes, ACTH-dependent forms (Cushing disease from a pituitary corticotroph adenoma ~70%, ectopic ACTH/CRH ~10%) outnumber ACTH-independent adrenal causes (adrenal adenoma, carcinoma, bilateral macronodular hyperplasia ~20%). The phenotype combines central obesity, moon face, dorsocervical and supraclavicular fat pads, purple striae, proximal myopathy, easy bruising, thin skin, hypertension, hyperglycaemia and osteoporosis. Diagnosis requires two abnor
Candidate tasks
- Clarify onset, severity, associated features, and red-flag symptoms.
- State focused examination priorities.
- List first-line investigations and any named score/criteria.
- Give immediate resuscitation steps.
- Outline definitive management with doses/routes where standard.
- Name complications and disposition (ward / HDU / theatre / discharge safety-net).
- Mention one special-population modifier (pregnancy, child, elderly, CKD).
Examiner checklist
| Domain | Pass behaviours |
|---|---|
| Definition | Correct working diagnosis language |
| Assessment | Focused, prioritised, red flags sought |
| Investigations | Appropriate first-line + interpretation |
| Emergency care | ABC / time-critical actions first |
| Definitive care | Specific drugs/procedures, not generic phrases |
| Safety | Central obesity + purple striae + proximal myopathy + easy bruising + hypertensi |
| Safety | Hypokalaemia with metabolic alkalosis in a non-oedematous patient - ectopic ACTH |
| Safety | Severe hypokalaemia, proximal myopathy and hyperpigmentation with very high cort |
| Communication | Clear plan and safety-netting |
Model outline
Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.