See also the Cushing's Journal at http://www.cushings-help.com/documents/cushings-journal.xls
Note: Not every patient has every symptom. Do not
attempt to diagnose yourself. This list is a partial checklist of frequently-noticed symptoms. Carefully filling out this checklist and taking it to your medical
personnel can be an important first step in getting appropriate testing and
the proper medical diagnosis. Please
show this to your qualified medical personnel. Print these symptoms to
take to your doctor to help with your diagnosis. Check off each day that you have observed this
symptom. Rank symptoms on a scale of 1 (present, but not bad), 2 (fair), 3 (bad) and 4
(unbearable!). Also helpful to take are
any past medical records; pictures of yourself when you were thinner, had more
hair, no straie, etc.
Doctor's Name____________________________ Today's Date: ____________________________ Page ___ of ____ First
Noticed Hair First
Noticed Other Symptoms You
Have... If using this Checklist � in another publication, please include a link back to this page, if
on the web; or the URL (http://www.cushings-help.com)
in publications; and the name Mary Kelly O'Connor, editor and founder of Cushings-Help.com. Please also with the web
page or publication information.
Please read the Important Disclaimer at http://www.cushings-help.com/disclaimer.htm.
Your Name: __________________________________
Possible
Symptoms
Date
Date
Date
Date
Date
Date
Date
Excess facial hair
or growth on the neck, chest,
abdomen, thighs, in women (Hirsuitism)
C, P, PM
Male pattern baldness
P, T
Hair loss, round bald patches on the scalp
AA
Hair loss, loss of facial and scalp hair
AT, L, T
Hair loss or
thinning. Head or whole body PM
Loss of hair in outer eyebrow
T
Hair is rough, coarse dry, breaking, brittle
T
Possible
Symptoms
Date
Date
Date
Date
Date
Date
Date
Comments: