A 35-year-old male window cleaner presented with muscle weakness. This mainly affect
ed his thighs with the result that he sometimes had to use his hands to help himself up from a sitti
ng position. He was also finding it difficult to climb ladders at work. He had no other complaints.
On examination, he had a cushingoid appearance with truncal obesity, proximal muscle
wasting, violaceous abdominal striae and a plethoric, ‘moon face’. His blood pressure was 180/11
0 mmHg. He admitted that he had noticed the changes in his appearance developing over the past
nine months but had been too shy to seek medical advice. It was only when he became concerned
that he might not be able to continue working that he consulted his doctor. He was admitted to ho
spital for further investigation.