Cushing Syndrome vs Cushing Disease requires clinical distinction that boards test directly. Cushing syndrome = any source of glucocorticoid excess: exogenous steroids (most common), adrenal adenoma, ectopic ACTH (small cell lung cancer, carcinoid). Cushing disease specifically = ACTH-secreting pituitary adenoma driving bilateral adrenal hyperplasia — same clinical appearance but the source is the pituitary. The clinical picture is identical regardless of cause: central obesity, moon face, supraclavicular fat pads, buffalo hump, purple striae (wide, >1 cm), proximal muscle wasting (patient cannot rise from chair without arm assistance), hypertension, hyperglycemia/steroid diabetes, poor wound healing, thin/fragile skin, osteoporosis, immunosuppression. Nursing priorities: infection surveillance (cortisol excess masks fever and blunts immune response — watch for subtle signs); blood glucose monitoring for steroid-induced diabetes; fall and fracture precautions (osteoporosis + muscle weakness); and skin integrity assessment. Boards trap: treating cortisol excess as protective — excess cortisol is pathologic and toxic, not therapeutic.