Is it simple obesity and hypertension, or Cushing’s disease?

Case scenario

‘Robyn’ is new to you and is seeing you to re-check her blood pressure. On a previous visit to your colleague, Robyn’s blood pressure was 152/96 mmHg. Given her family history (father developing diabetes at age 45 and dying of a myocardial infarct at age 51), her being overweight (weight 75 kg, height 160 cm, BMI 29.3 kg/m² [overwight BMI is 25 to 30 kg/m²]) and her age of 46, your colleague and Robyn were concerned about her future risk of heart disease.

Her blood pressure is still high (150/94 mmHg), but you are struck by her florid appearance (Figure 1) and wonder if she has Cushing’s syndrome as the cause of her hypertension and overweight.