Moon face

Moon face, a distinctive facial adiposity, usually indicates hypercortisolism resulting from ectopic or excessive pituitary production of corticotropin, adrenal adenoma or carcinoma, or long-term glucocorticoid therapy. Its typical characteristics include marked facial roundness and puffiness, a double chin, a prominent upper lip, and full supraclavicular fossae. Although the presence of moon face doesn’t help differentiate causes of hypercortisolism, it does indicate a need for diagnostic testing.

History and physical examination

Ask the patient when he first noticed his facial adiposity, and try to obtain a preonset photograph to help evaluate the extent of the change.

Ask about weight gain and any personal or family history of endocrine disorders, obesity, or cancer. Has the patient noticed any fatigue, irritability, depression, or confusion? If the patient is a female of childbearing age, determine the date of her last menses and whether she’s experienced any menstrual irregularities.

If the patient is receiving a glucocorticoid, ask the name of the drug, dosage and schedule, route of administration, and reason for therapy. Also ask if the dosage has ever been modified and, if so, when and why.

Take the patient’s vital signs, weight, and height. Assess the patient’s overall appearance for other characteristic signs of hypercortisolism, including virilism in a female or gynecomastia in a male. Also assess for purple striae on the skin, muscle weakness due to loss of muscle mass from increased catabolism, and skeletal growth retardation in children.

Medical causes

Hypercortisolism

Moon face varies in severity, depending on the degree of cortisol excess and weight gain. The patient typically exhibits buffalo hump, truncal obesity with slender arms and legs, and thin, transparent skin with purple striae and ecchymoses. Other cushingoid features include acne, diaphoresis, fatigue, muscle wasting and weakness, poor wound healing, elevated blood pressure, and personality changes.

In addition to these findings, a woman may experience hirsutism and amenorrhea or oligomenorrhea; a man may experience gynecomastia and impotence.

Other causes

Drugs

Most cases (more than 99%) of moon face result from prolonged use of a glucocorticoid, such as cortisone, dexamethasone, hydrocortisone, or prednisone.

Special considerations

Relieve the patient’s concern about his body image by explaining that moon face and other disconcerting cushingoid effects can usually be corrected by treating the underlying disorder or by discontinuing or modifying glucocorticoid therapy. Explain to the patient that he should only discontinue or modify glucocorticoid therapy as directed by the physician.

Clearly explain to the patient any diagnostic tests ordered. These may include serum and urine 17-hydroxycorticosteroid studies; a 2-day, low-dose dexamethasone test followed by a 2-day, high-dose dexamethasone test; plasma corticotropin studies; and a corticotropin-releasing hormone test.

Pediatric pointers

Moon face is rare in children. In an infant or a young child, it usually indicates adrenal adenoma or carcinoma or, rarely, cri du chat syndrome. After age 7, it usually indicates abnormal pituitary secretion of corticotropin in bilateral adrenal hyperplasia.

Book Source Details

• Book Title: Professional Guide to Signs & Symptoms (Fifth Edition)
• Author(s): Springhouse
• Year of Publication: 2006
• Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2006 Lippincott Williams & Wilkins.

Other Book Chapters Related to Face symptoms

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Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2008 Williams & Wilkins.

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• Back to symptom: Face symptoms: Introduction (review 4431 causes)
• Next Book Extract About Face symptoms: Throat pain (Professional Guide to Signs & Symptoms (Fifth Edition))
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More About This Book: Title: Professional Guide to Signs & Symptoms (Fifth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-510-9

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