The Face of Excess Cortisol: Clinical and Morphologic Insights Into Cushing Syndrome

Cushing syndrome (CS) is characterized by excess cortisol and distinct facial features, including moon face and facial fat accumulation. However, facial fat distribution differences between CS and common obesity remain unclear. This study used 3-dimensional photogrammetry to quantify facial characteristics influenced by cortisol.

Patients with CS and controls were recruited at Peking Union Medical College Hospital from 2022 to 2024. Enrolled patients underwent standardized protocols for 3-dimensional facial imaging and clinical data collection. The images were subsequently processed, annotated, and subjected to measurement analysis. Distances, angles, contours, and area parameters were measured and calculated. Differences in facial features between patients with CS and obesity controls were compared. Clinical features related to CS facial features were analyzed. A support vector machine-based diagnostic model was developed using distinct facial features.

A total of 42 patients with CS and 42 controls were enrolled (age, sex, and body mass index matched). Measurement values of CS facial parameters revealed significant cheek and lower face fat accumulation compared with common obesity, with more pronounced lower face accumulation. Fat accumulation in CS occurred in both horizontal and depth dimensions. Associated factors included age, sex, body mass index, waist circumference, disease duration, cortisol and adrenocorticotropic hormone levels, and etiologic subtype. The support vector machine diagnostic model showed accuracy of 91.7% and area under the curve of 0.96.

Compared with common obesity, hypercortisolism induces a redistribution of facial fat toward the mid and lower face regions, resulting in the characteristic appearance. This study of excessive endogenous cortisol secretion offers new clinical and facial morphologic perspectives on CS.