In Cushing's syndrome, how do calcium levels typically present?

• A. Elevated
• B. Normal
• C. Decreased
• D. Unchanged

Answer: (C)

Glucocorticoid excess disrupts calcium balance in several ways, and this is what the question is testing. When cortisol levels are high, bone formation is suppressed and bone resorption is influenced in a way that the bone matrix is depleted, leading to osteoporosis over time. At the same time, glucocorticoids reduce calcium absorption from the gut and increase calcium loss by the kidneys. This combination creates a negative calcium balance overall. Although some calcium can be released from bone, the decreased absorption and increased excretion usually make serum calcium trend toward normal or lower, with decreased being a common presentation in this context. Hypercalcemia is not typical for Cushing’s syndrome, as that would point to other causes such as hyperparathyroidism or certain malignancies. So, the best answer reflects the tendency toward decreased calcium levels.