Supraclavicular Fat Pads as the Chief Complaint of Cushing's Syndrome

We report on a case of a woman who sought medical assistance for bilateral supraclavicular fat pads due to Cushing’s syndrome. Our case underscores the importance of recognizing the cosmetic manifestations of Cushing’s syndrome as a chief complaint and a trigger for diagnosis. A 62-year-old, previously healthy woman, visited our office with the chief complaint of masses at the bilateral supraclavicular fossae (Figure 1). She noticed that the mass had gradually grown over the previous few months. She also complained of a general fatigue that had lasted for several months. She denied any pain or tenderness around the mass, dyspnea, recent weight gain, or fat accumulation at other sites. She had never been diagnosed as obese at previous health checks. At her first hospital visit, her height was 159 cm, body weight was 60.5 kg, and body mass index (BMI) was 23.9 kg/m2. Physical examinations revealed non-tender, symmetric, soft lumps filling the supraclavicular fossae, and bipedal edema. Careful examination revealed mild fat accumulation at the nuchal area to the bilateral shoulder, which suggested a “buffalo hump”; however, “moon face” was not observed. Laboratory examination revealed elevated serum cortisol at rest and 24-hour urinary free cortisol and loss of diurnal variation of serum cortisol with low serum Figure 1.