**Question:** Common sites for Cushing ulcers include all of the following except

A. Abdomen
B. Back
C. Chest
D. Head and neck

**Core Concept:**
Cushing's syndrome is a condition characterized by chronic hypercortisolism due to excessive cortisol secretion from the adrenal glands. One common manifestation of Cushing's syndrome is Cushing ulcers, which are a result of prolonged cortisol exposure. Cushing ulcers occur at sites of increased cortisol action, such as:

**Why the Correct Answer is Right:**
Cushing ulcers are primarily found in sites with high cortisol action, such as the abdomen, back, and chest. While abdominal and back ulcers are common in Cushing's syndrome, ulcers on the chest are relatively rare due to limited cortisol action in this area.

**Why Each Wrong Option is Incorrect:**
A. Abdomen: Ulcers in the abdomen are common in Cushing's syndrome, as cortisol promotes the breakdown of collagen and increases gastric acid secretion, leading to peptic ulcers.
B. Back: Although ulcers on the back might occur due to prolonged cortisol exposure, they are less common than abdominal ulcers.
C. Chest: Ulcers on the chest are relatively rare in Cushing's syndrome, as cortisol's effects on the chest are limited.
D. Head and neck: While cortisol can affect the head and neck, ulcers are less common than abdominal and back ulcers in Cushing's syndrome.

**Clinical Pearl:**
Cushing ulcers are a crucial manifestation of Cushing's syndrome, particularly in the abdomen and back. Recognizing these ulcers can help in diagnosing the underlying etiology and initiating timely management.