Which of the following presentations is most indicative of Cushing's syndrome?

The presentation that includes moon facies and a buffalo hump is the most indicative of Cushing's syndrome. Cushing’s syndrome is characterized by prolonged exposure to elevated cortisol levels, which can be due to various causes, such as pituitary adenomas (Cushing's disease), adrenal tumors, or ectopic ACTH production.

Moon facies refers to the round, puffy appearance of the face that occurs due to fat redistribution. This is a hallmark feature of Cushing's syndrome, as the increased cortisol promotes fat deposition in the facial area. The buffalo hump describes the accumulation of adipose tissue in the cervical region, specifically at the base of the neck, another common physical manifestation of Cushing's syndrome.

This combination of symptoms—moon facies and buffalo hump—strongly indicates the hormonal effects of increased cortisol, making it a classic presentation of this condition. In contrast to the other options, which may have some overlap with conditions found in other disorders, the specific combination of these two features is quite distinctive to Cushing’s syndrome.