Materiały źródłowe

• #1 Cushing syndrome: Amy Schumer shares details. What is it?

  https://www.usatoday.com/story/life/health-wellness/2025/01/23/cushing-syndrome-amy-schumer-health/77901103007/

  Internet trolls partly aided doctors in diagnosing Amy Schumer with Cushing syndrome, but patients can go years without a diagnosis. […] Cushing syndrome can be difficult to diagnose because providers dont immediately think of the condition when a patient comes into the office reporting fatigue and weight gain. […] The average diagnostic delay in Cushing’s syndrome is approximately two to three years. […] To determine if a patient has Cushing syndrome, doctors conduct tests to find out if the body is making too much cortisol, Yogi-Morren said. […] Once doctors have a confirmed diagnosis, the next step is determining the cause. […] If a patient isnt on medication, the doctor will order scans to see if there might be a tumor causing Cushing syndrome.

• #2 Understanding Cushing’s Disease – Diagnosis & Treatment

  https://isturisa.com/hcp/diagnosis-treatment/

  Cushings disease (CD) is often overlooked, with an average time to diagnosis of 7 years. Diagnosis begins with screening for elevated endogenous cortisol. While some features are more discriminatory to indicate Cushings syndrome (CS), diagnosis of CD begins with screening for elevated endogenous cortisol. Testing options to determine a CD diagnosis include late-night salivary cortisol (LNSC) test, 24-hour UFC, overnight 1-mg DST, 48-hour, 2-mg/d DST, IPSS, and CRH screening. IPSS measures ACTH levels in the pituitary gland vs ACTH levels in the peripheral blood; the gold standard test to determine if the source of ACTH is from the pituitary gland or an ectopic source. As soon as you diagnose CD, it is critical to initiate treatment to minimize further complications.

• #3 Cushing syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cushing-syndrome/diagnosis-treatment/drc-20351314

  Taking glucocorticoid medicines is the most common way to get Cushing syndrome. Your health care provider can look at all your medicines pills, injections, creams and inhalers to see if you’re taking medicines that can cause the syndrome. If you are, you won’t need other tests. […] When Cushing syndrome is caused by the body making too much cortisol, it can be hard to diagnose. That’s because other illnesses have similar symptoms. Diagnosing Cushing syndrome can be a long and complex process. You’ll need to see a doctor who specializes in hormonal diseases, called an endocrinologist. […] The endocrinologist likely will do a physical exam and look for signs of Cushing syndrome, such as a round face, a hump on the back of the neck, and thin, bruised skin with stretch marks. […] These tests help your health care provider diagnose Cushing syndrome. They also may help rule out other health conditions, such as polycystic ovary syndrome a hormone problem in people with enlarged ovaries. Depression, eating disorders and alcoholism also can have symptoms similar to Cushing syndrome.

• #4 Cushing Syndrome: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/5497-cushing-syndrome

  Cushing syndrome can sometimes be difficult to diagnose. If you tell your provider you have fatigue and weight gain, they might not immediately think of Cushing syndrome. These types of symptoms are common to many different kinds of diseases. […] Cushing syndrome is also sometimes mistaken for polycystic ovary syndrome or metabolic syndrome. Your healthcare provider will have to go through a process of elimination to rule out other conditions. […] When your healthcare provider suspects hypercortisolism, there are certain guidelines they may follow. Theyll ask questions, look at your medical history, perform a physical examination and then conduct some laboratory tests. Theyll likely continue to monitor you over time. […] Your healthcare provider is likely to request some of the following tests: 24-hour urinary cortisol test: This test measures the amount of cortisol in micrograms (mcg) in your urine. Your healthcare provider will have you collect your urine (pee) over a period of 24 hours.

• #5 Diagnosis of Cushing’s Syndrome Guideline Resources | Endocrine Society

  https://www.endocrine.org/clinical-practice-guidelines/diagnosis-of-cushing-syndrome

  We recommend obtaining a thorough drug history to exclude excessive exogenous glucocorticoid exposure leading to iatrogenic Cushings syndrome before conducting biochemical testing. […] We recommend testing for Cushings syndrome in the following groups: Patients with unusual features for age (e.g. osteoporosis, hypertension) […] Patients with multiple and progressive features, particularly those who are more predictive of Cushings syndrome […] Children with decreasing height percentile and increasing weight […] Patients with adrenal incidentaloma compatible with adenoma. […] For the initial testing for Cushings syndrome, we recommend one of the following tests based on its suitability for a given patient: Urine free cortisol (UFC; at least two measurements) […] Late-night salivary cortisol (two measurements)

• #5 Diagnosis of Cushing’s Syndrome Guideline Resources | Endocrine Society

  https://www.endocrine.org/clinical-practice-guidelines/diagnosis-of-cushing-syndrome

  1-mg overnight dexamethasone suppression test (DST) […] Longer low-dose DST (2| mg/d for 48 h). […] In individuals with normal test results in whom the pretest probability is high (patients with clinical features suggestive of Cushings syndrome and adrenal incidentaloma or suspected cyclic hypercortisolism), we recommend further evaluation by an endocrinologist to confirm or exclude the diagnosis. […] In individuals with at least one abnormal test result (for whom the results could be falsely positive or indicate Cushings syndrome), we recommend further evaluation by an endocrinologist to confirm or exclude the diagnosis. […] For the subsequent evaluation of abnormal initial test results, we recommend performing another recommended test. […] We recommend against any further testing for Cushings syndrome in individuals with concordantly negative results on two different tests (except in patients suspected of having the very rare case of cyclical disease).

• #5 Diagnosis of Cushing’s Syndrome Guideline Resources | Endocrine Society

  https://www.endocrine.org/clinical-practice-guidelines/diagnosis-of-cushing-syndrome

  The 2008 guideline on the diagnosis of Cushings Syndrome: […] Provides recommendations for the diagnosis of Cushings Syndrome […] Emphasizes early recognition of Cushings Syndrome to reduce the risk of residual morbidity. […] The diagnosis can be challenging in mild cases: Endocrine Society (ES) recommends initial use of one test with high diagnostic accuracy (urine free cortisol [UFC], late night salivary cortisol, 1-mg overnight or 2-mg 48-h dexamethasone suppression test). […] Testing for Cushings syndrome in certain high-risk populations has shown an unexpectedly high incidence of unrecognized Cushings syndrome as compared with the general population. […] Caregivers are encouraged to consider Cushings syndrome as a secondary cause of these conditions, particularly if additional features of the disorder are present. If Cushings syndrome is not considered, the diagnosis is all too often delayed.

• #6 Establishing the diagnosis of Cushing syndrome – UpToDate

  https://www.uptodate.com/contents/establishing-the-diagnosis-of-cushing-syndrome

  Establishing the diagnosis of Cushing syndrome […] The possible presence of Cushing syndrome is suggested by certain symptoms and signs. Unfortunately, none of these are pathognomonic, and many are nonspecific (eg, obesity, hypertension, menstrual irregularity, and glucose intolerance). As a result, the diagnosis must be confirmed by biochemical tests. The diagnosis of Cushing syndrome involves three steps: suspecting it on the basis of the patient’s symptoms and signs, documenting the presence of hypercortisolism, and determining its cause. The evaluation to determine if the patient has hypercortisolism (Cushing syndrome) will be reviewed here. […] We suggest testing for hypercortisolism in patients in whom a diagnosis is most likely, including the following: Unusual findings for their age (osteoporosis or hypertension in young adults). Multiple progressive features of Cushing syndrome, particularly those that are predictive of Cushing syndrome such as facial plethora, proximal myopathy, striae (>1 cm wide and red/purple), and easy bruising. Unexplained severe features (resistant hypertension, osteoporosis) at any age.

• #7 Cushing’s Syndrome – NIDDK

  https://www.niddk.nih.gov/health-information/endocrine-diseases/cushings-syndrome

  Cushings syndrome can be hard to diagnose. Symptoms such as fatigue and weight gain can have many different causes. Cushings syndrome may be mistaken for other conditions that have many of the same signs, such as polycystic ovary syndrome or metabolic syndrome. Your doctor will first want to rule out other conditions. […] Diagnosis is based on your medical history, a physical exam, and lab tests. Your doctor may ask if you are taking glucocorticoids or have had injections and rule that out before ordering lab tests. […] Doctors may use urine, saliva, or blood tests to diagnose Cushings syndrome. Sometimes doctors run a follow-up test to find out if excess cortisol is caused by Cushings syndrome or has a different cause. […] No one test is perfect, so doctors usually do two of the following tests to confirm a diagnosis:

• #7 Cushing’s Syndrome – NIDDK

  https://www.niddk.nih.gov/health-information/endocrine-diseases/cushings-syndrome

  In this test, you will collect your urine over a 24-hour period. Your health care professional will send your urine sample to a lab to test cortisol levels. Higher than normal cortisol levels suggest Cushings syndrome. […] This test measures the amount of cortisol in your saliva in the late evening. Normally, cortisol production drops just after we fall asleep. In Cushings syndrome, cortisol levels dont drop. You can collect your saliva sample at home and return it to your health care professional or send it to a lab for testing. […] In this test, you will take a low dose of dexamethasone, a type of glucocorticoid, usually around 11:00 p.m. A health care professional will draw your blood the following morning, usually around 8 a.m. Sometimes doctors use another type of LDDST test, in which you take dexamethasone every 6 hours for 48 hours. Your blood is drawn 6 hours after the last dose.

• #7 Cushing’s Syndrome – NIDDK

  https://www.niddk.nih.gov/health-information/endocrine-diseases/cushings-syndrome

  Normally, cortisol levels in the blood drop after taking dexamethasone. Cortisol levels that dont drop suggest Cushings syndrome. […] Once your doctor diagnoses Cushings syndrome, other tests can help tell whether the source of the problem is pituitary, ectopic, or adrenal. Knowing the source is important in choosing the best type of treatment. […] The first step is to measure ACTH levels in the blood. If ACTH levels are low, the cause is probably an adrenal tumor. People with adrenal tumors dont need further blood tests. […] If ACTH levels are normal or high, the cause is probably a pituitary or ectopic tumor. […] Other blood tests help tell pituitary tumors from ectopic tumors. Doctors usually do more than one test. […] For this test, youll get a shot of CRH. If you have a pituitary tumor, CRH will increase the ACTH and cortisol in your blood. This rarely happens in people with ectopic tumors.

• #7 Cushing’s Syndrome – NIDDK

  https://www.niddk.nih.gov/health-information/endocrine-diseases/cushings-syndrome

  This test is the same as the LDDST, except it uses higher doses of dexamethasone. If the cortisol levels in your blood drop after taking a high dose of dexamethasone, you probably have a pituitary tumor. If your cortisol levels dont drop, you may have an ectopic tumor. […] Imaging tests show the size and shape of the pituitary and adrenal glands and look for tumors. If blood tests show that the tumor is ectopic, imaging tests can help locate the tumor. The most common imaging tests are the computerized tomography (CT) scan and magnetic resonance imaging (MRI). […] Pituitary tumors are usually small and may not show up in an imaging test. If an MRI doesnt show a pituitary tumor, you might have petrosal sinus sampling. This test is often the best way to tell pituitary from ectopic causes of Cushing’s syndrome.

• #8 Cushing’s syndrome: a practical approach to diagnosis and differential diagnoses | Journal of Clinical Pathology

  https://jcp.bmj.com/content/70/4/350

  The American Endocrine Society Clinical Guidelines (2008) recommends one of the four following tests for the initial screening of CS: two measurements of urinary-free cortisol (UFC), two measurements of late night salivary cortisol (LNSC), 1 mg overnight dexamethasone suppression test (ODST) or a longer low-dose dexamethasone suppression test (LDDST) with 2mg/day in divided doses for 48hours. The decision regarding suitability of the appropriate initial screening test should be made by the clinician, the patient and the local availability of the tests. Conventionally, UFC and ODST are the preferred tests by most centres/clinicians. […] Following the initial positive screening tests for the possibility of CS, clinicians should proceed with further diagnostic investigations for biochemical characterisation of the disease. This should then be followed by anatomical localisation studies for subsequent management. […] If two of the initial screening tests are positive with a high pre-test probability of the disease, diagnosis of CS is almost certain in that patient. Simultaneous or sequential screening tests with or without other tests could help in establishing the biochemical confirmation of CS.

• #8 Cushing’s syndrome: a practical approach to diagnosis and differential diagnoses | Journal of Clinical Pathology

  https://jcp.bmj.com/content/70/4/350

  Diagnosis of Cushing’s syndrome (CS) and identification of the aetiology of hypercortisolism can be challenging. The Endocrine Society clinical practice guidelines recommends one of the four tests for initial screening of CS, namely, urinary-free cortisol, late night salivary cortisol, overnight dexamethasone suppression test or a longer low-dose dexamethasone suppression test, for 48hours. Confirmation and localisation of CS requires additional biochemical and radiological tests. Radiological evaluation involves different imaging modalities including MRI with or without different radio-nuclear imaging techniques. Invasive testing such as bilateral inferior petrosal sinus sampling may be necessary in some patients for accurate localisation of the cause for hypercortisolism. […] CS is known to cause increased morbidity and mortality. Therefore, prompt clinical suspicion, early diagnostic work-up and management are necessary to avoid potential adverse outcomes. This best practice article compiles an evidence-based practical approach to empower clinicians and laboratory personnel for diagnostic evaluation of CS with the most up-to-date scientific literature.

• #9 Cushing’s Disease: Clinical Manifestations and Diagnostic Evaluation | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0901/p1119.html/

  A more recent article on Cushing’s syndrome is available. […] The evaluation of patients with suspected Cushing’s disease and syndrome requires an understanding of the proper use and limitations of the tests commonly included in the diagnostic work-up. The best screening test for Cushing’s syndrome is a 24-hour urine collection with analysis for urinary free cortisol excretion. Low-dose and high-dose dexamethasone suppression tests, corticotropin assays, a corticotropin-releasing hormone stimulation test and inferior petrosal sinus catheterization may be required for a definitive diagnosis. […] When Cushing’s syndrome is suspected, initial laboratory testing is usually directed at confirming excessive glucocorticoid production. This is best accomplished through analysis of a 24-hour urine collection for urinary free cortisol excretion. Normal values are less than 90 g per 24 hours (250 nmol per day). Values more than 300 g per day (830 nmol per day) are considered diagnostic for Cushing’s syndrome.

• #9 Cushing’s Disease: Clinical Manifestations and Diagnostic Evaluation | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0901/p1119.html/

  If the result of the dexamethasone suppression test is abnormal or the 24-hour urinary free cortisol level is mildly elevated, a confirmatory test for Cushing’s syndrome is needed. […] Once hypersecretion of cortisol is confirmed, the next step is to determine whether the pathologic state is ACTH dependent or ACTH independent. This can be accomplished through measurement of the late-afternoon ACTH level. […] If the process is ACTH dependent, a high-dose dexamethasone suppression test combined with cranial MRI studies may aid in localizing the site of ACTH overproduction. […] If the results of the work-up to this point are equivocal or the work-up suggests ectopic ACTH production, inferior petrosal sinus sampling is indicated. This procedure is considered the gold standard for definitive diagnosis of ACTH-dependent lesions. […] A petrosal sinustoperipheral ACTH ratio of 2:1 is considered diagnostic for a pituitary source. […] The diagnostic accuracy of the test exceeds 95 percent.

• #10 Diagnosis of Cushing’s Syndrome (Hypercortisolism)

  https://www.adrenal.com/cushing-syndrome/diagnosis

  This is the concept behind the dexamethasone suppression test and it is a very reliable test to diagnose Cushing syndrome, and quite straightforward to perform. Thus, it is often the #1 screening test for Cushing syndrome. […] Saliva is easy to collect and cortisol is stable at room temperature that allows the samples to be mailed to the medical office or laboratory for analysis. These advantages make the late-night salivary cortisol a convenient, suitable, and reliable procedure for both inpatient and outpatient screening for Cushing syndrome. […] The recommendation is to use the upper limit of normal range for the particular UFC assay as the cutoff criterion for a positive test in order to achieve high sensitivity, and to perform the test twice, at least once. […] After the diagnosis of hypercortisolism has been established by the biochemical (blood, urine, saliva) test described above, the next step is to establish the underlying cause of Cushing Syndrome. Establishing the right diagnosis is essential, because the primary curative therapy for ACTH- independent Cushing syndrome is adrenal surgery.

• #11 Endogenous Cushing Syndrome Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/2233083-workup

  This concept gives rise to the following tests, which have been recommended as screening tests for Cushing syndrome: Midnight serum or salivary cortisol, 24-hour urinary free cortisol, Low dose dexamethasone suppression test. […] Urinary free cortisol (UFC) determination has been widely used as an initial screening tool for Cushing syndrome because it provides measurement of cortisol over a 24-hour period. A valid result depends on adequate collection of the specimen. […] Urinary free cortisol values higher than 3 times the upper limit of normal are highly suggestive of Cushing syndrome. […] The rationale for the dexamethasone suppression test is based on the normal physiology of the HPA axis; glucocorticoids inhibit secretion of hypothalamic CRH and pituitary ACTH. […] The overnight 1-mg dexamethasone suppression test requires administration of 1 mg of dexamethasone at 11 PM, with subsequent measurement of cortisol level at 8 am.

• #11 Endogenous Cushing Syndrome Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/2233083-workup

  Late-night serum and salivary cortisol levels take advantage of the alterations in circadian rhythm of cortisol secretion in patients with Cushing syndrome. […] Measuring salivary cortisol level has gained interest, as it is a simple and convenient way of obtaining a nighttime sample. […] Results from a meta-analysis of 7 studies related to late-night salivary cortisol testing in the diagnosis of Cushing syndrome indicated that such testing has a sensitivity of 92% and a specificity of 96%. […] The dexamethasone-CRH test is intended to distinguish patients with Cushing syndrome from those with pseudo-Cushing states. […] Once the diagnosis is established, the next step requires determining the etiology of Cushing syndrome. […] In a patient in whom the diagnosis of Cushing syndrome has been established, an undetectable plasma ACTH with a simultaneously elevated serum cortisol level is diagnostic of ACTH-independent Cushing syndrome.

• #11 Endogenous Cushing Syndrome Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/2233083-workup

  The diagnosis of Cushing syndrome due to endogenous overproduction of cortisol requires the demonstration of inappropriately high serum cortisol or urinary cortisol levels. Currently, 4 methods are accepted for the diagnosis of Cushing syndrome: urinary free cortisol level, low-dose dexamethasone suppression test, evening serum and salivary cortisol level, and dexamethasone-corticotropin-releasing hormone test. […] Imaging studies for Cushing syndrome should be performed after the biochemical evaluation has been performed. Ideally, the biochemical abnormalities should reconcile with the anatomic abnormalities before definitive therapy is offered. […] The diagnosis of Cushing syndrome requires demonstration of inappropriately high levels of cortisol in the serum or urine. The levels should be measured when cortisol, according to its physiologic circadian rhythm, is supposed to be suppressed, that is, late evening, or when a patient is given exogenous glucocorticoids.

• #11 Endogenous Cushing Syndrome Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/2233083-workup

  The 8-mg overnight dexamethasone suppression test and the 48-hour high-dose dexamethasone test may be useful when baseline ACTH levels are indeterminate. […] Testing with CRH is used in the differential diagnosis of ACTH-dependent Cushing syndrome. […] Acute illness activates the HPA axis, resulting in increases in ACTH and cortisol. The laboratory workup for Cushing syndrome should not be performed when subjects are acutely ill. […] If concern for adrenal carcinoma exists, measurements of adrenal androgen production, such as serum dehydroepiandrosterone sulfate (DHEAS), and 24-hour urinary 17-ketosteroid measurements may be helpful.

• #12 Diagnostic Testing for Cushing’s Syndrome – CSRF – Cushing’s Support & Research Foundation

  https://csrf.net/understanding-cushings/diagnostic-testing/

  A 24 hour urine free cortisol level does reflect the cortisol secretion throughout an entire day. […] Although the majority of patients with Cushings have elevated levels of urine free cortisol, it is becoming increasingly evident that many patients with mild Cushings syndrome will actually have normal levels of urine free cortisol. […] The low-dose dexamethasone suppression testing has been used for four decades as a diagnostic tool in the evaluation of patients with suspected Cushings syndrome. […] Normal subjects should suppress their cortisol level to a very low level (1.8 g/dl) after dexamethasone. […] The first step in distinguishing the type of Cushings syndrome is a blood test for the measurement of ACTH obtained in the morning. […] Distinguishing a pituitary from a non-pituitary ACTH-secreting tumor may be a diagnostic challenge.

• #12 Diagnostic Testing for Cushing’s Syndrome – CSRF – Cushing’s Support & Research Foundation

  https://csrf.net/understanding-cushings/diagnostic-testing/

  The diagnostic approach to patients with suspected Cushings Syndrome has been published in an evidence-based guideline by the Endocrine Society. […] A screening laboratory evaluation for Cushings syndrome should be considered in any patient with signs and symptoms of excessive cortisol secretion. […] The diagnostic approach to patients with suspected Cushings syndrome has been published in an evidence-based guideline by the Endocrine Society. […] Three diagnostic studies are currently recommended: late-night salivary cortisol, 24 hour urine free cortisol, low-dose dexamethasone suppression. […] Late-night salivary cortisol is one of the most sensitive diagnostic tests for Cushings syndrome. […] It is the most widely studied single test for the diagnosis of Cushings syndrome with many studies from all over the world demonstrating a sensitivity of 93-100% for the diagnosis of Cushings syndrome; however, like all the tests for Cushings syndrome there are many things which may cause a false positive result and additional testing is always needed.

• #12 Diagnostic Testing for Cushing’s Syndrome – CSRF – Cushing’s Support & Research Foundation

  https://csrf.net/understanding-cushings/diagnostic-testing/

  For patients with an ACTH secreting tumor causing Cushings syndrome and a normal pituitary MRI, the single best test to confirm the presence or absence of an ACTH-secreting pituitary tumor is a procedure called inferior petrosal sinus sampling. […] CT scanning of the adrenal glands will be helpful in identifying whether this represents a solitary cortisol-producing tumor from the adrenal gland or whether there are large nodules in each adrenal gland resulting in cortisol excess. […] The diagnosis of Cushings syndrome is the most challenging problem in endocrinology and may be difficult for even experienced endocrinologists. […] The Endocrine Society guidelines recommend that one of the screening tests be performed (my personal preference is late-night salivary cortisol and/or the dexamethasone suppression test).

• #13 Cushing Syndrome: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/5497-cushing-syndrome

  Midnight salivary cortisol test: Typically, cortisol levels are very low late at night. This test checks cortisol levels between 11 p.m. and 12 a.m. If you have Cushing syndrome, your cortisol levels will be unusually high during that hour. […] Low-dose dexamethasone suppression test: Dexamethasone is a cortisol-like drug. For this test, you take one milligram (mg) of the drug by mouth at night and then measure cortisol levels between 8 a.m. and 9 a.m. This blood test determines if the adrenal glands responded to the dexamethasone by suppressing the amount of cortisol they secrete. If you have Cushing syndrome, your cortisol levels will remain high. […] Blood test: A blood test will measure the ACTH levels in your blood. An adrenal tumor might be there if the levels are low. If the levels are normal or high, there could be a pituitary or ectopic tumor.

• #13 Cushing Syndrome: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/5497-cushing-syndrome

  High-dose dexamethasone suppression test: This test is like the low-dose dexamethasone suppression test, but the dosage is 8 milligrams instead of one. A provider will typically perform this test after the low-dose test shows high levels of cortisol in the morning and when blood tests show high ACTH in the blood. This test can determine the source of Cushing syndrome, since it can tell the difference between a pituitary adenoma (Cushing disease) and a tumor elsewhere in your body (such as your lungs). […] Once your healthcare provider has confirmed that you have Cushing syndrome, the next step is to determine why. Often its medication or a tumor. If youre on glucocorticoids, thats probably the cause, and your healthcare provider will likely decrease the dosage. If youre not on glucocorticoids, that indicates theres likely a tumor in your adrenal glands, pituitary gland or elsewhere. Your healthcare provider may recommend the following imaging studies to reveal the location of the tumor: CAT scan (CT scan) or MRI abdomen: Your provider may perform a CT scan or MRI to look for a tumor in your adrenal glands. The provider can do these scans with or without IV contrast. The tests are very sensitive at identifying adrenal tumors.

• #13 Cushing Syndrome: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/5497-cushing-syndrome

  Magnetic resonance imaging (MRI) pituitary: An MRI will take a picture of your pituitary gland to see if theres a tumor. In some cases, the MRI wont provide a perfect diagnosis. Fifty percent of those with Cushing syndrome will have a normal MRI and 10% will have tumors unrelated to the syndrome. […] Bilateral inferior petrosal sinus sampling (BIPPS): This test finds the source of ACTH secretion. ACTH and other pituitary hormones go into the bloodstream from the pituitary gland. An experienced interventional radiologist will go through two veins known as the inferior petrosal sinuses. This test has a 95% to 98% accuracy rate. […] CT scan chest: If your provider suspects an ectopic tumor, theyll order a CT chest to look for possible lung cancer.

• #14 Recent Updates on the Diagnosis and Management of Cushing’s Syndrome

  https://www.e-enm.org/journal/view.php?number=1895

  The result of each cortisol screening test (saliva, serum, urine) is considered normal if it falls within the normal reference range; cortisol values 8 hours after administration of 1 mg dexamethasone at 2,300 to 2,400 hours should normally be 1.8 g/dL (50 nmol/L). […] Each test has important caveats, so that the choice of tests should be individualized for each patient, to minimize false positive and false negative results. […] A careful history, judicious choice of screening tests and observation over time increase the chance of making the correct diagnosis of Cushing’s syndrome.

• #15 Cushing Syndrome | Johns Hopkins Diabetes Guide

  https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_Diabetes_Guide/547032/all/Cushing_Syndrome

  Cushing syndrome is a condition associated with a constellation of signs and symptoms caused by prolonged exposure to high levels of glucocorticoids. […] The signs and symptoms most suggestive of underlying hypercortisolism include facial plethora, moon facies, proximal muscle weakness, central obesity with wasting of the extremities, wide purplish striae (1 cm), and easy bruising without obvious trauma. […] There are 3 first-line screening tests for evaluation of patients suspected to have CS: 1) low-dose dexamethasone suppression test (after 1mg dexamethasone taken at 11 PM, cortisol at 8 AM should be 1.8 mcg/dL); 2) 24-hour urine free cortisol (UFC); 3) late-night salivary cortisol (usually two samples collected). […] The presence of at least two abnormal test methods is usually needed to establish the diagnosis.

• #15 Cushing Syndrome | Johns Hopkins Diabetes Guide

  https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_Diabetes_Guide/547032/all/Cushing_Syndrome

  After confirming hypercortisolism, the ACTH level should be measured to identify if CS is ACTH-dependent or -independent. […] Low or undetectable ACTH ( 10 pg/mL) is consistent with ACTH-independent hypercortisolism from an adrenal source which may include adrenal adenoma, adrenal hyperplasia, or adrenal carcinoma. […] The presence of a plasma ACTH level 20 pg/mL suggests ACTH-dependent Cushings syndrome. […] Inferior petrosal sinus sampling (IPSS) is the gold standard to distinguish Cushing disease from ectopic ACTH syndrome. […] The workup of patients with ectopic ACTH syndrome may include CT or MRI of neck/chest/abdomen/pelvis and nuclear imaging studies such as octreotide, Gallium-68 Dotatate, and positron emission tomography (PET) scans. […] Pseudo-Cushing syndrome: non-pathologic excess cortisol secretion not caused by CS which may be seen in pregnancy, morbid obesity, severe stress, severe psychological stress (including major depressive disorder), uncontrolled diabetes, chronic alcoholism, and severe sleep apnea.

• #16 Establishing the cause of Cushing syndrome – UpToDate

  https://www.uptodate.com/contents/establishing-the-cause-of-cushing-syndrome

  Cushing syndrome may be caused by excessive corticotropin (ACTH) secretion from a pituitary or nonpituitary ACTH-secreting tumor, which drives adrenal cortisol production (termed ACTH-dependent), or by autonomous adrenal secretion of excessive amounts of cortisol, which is not stimulated by ACTH (termed ACTH-independent). […] Measure plasma ACTH — The first step to distinguish between these is to measure plasma corticotropin (ACTH).

• #17 Cushing Syndrome: Signs, Causes, and Treatment

  https://www.healthline.com/health/cushings-syndrome

  After you receive a diagnosis of Cushing syndrome, a doctor must still determine the cause of the excess cortisol production. […] Tests to help determine the cause may include: Blood ACTH test: Low ACTH levels and high cortisol levels may indicate the presence of an adrenal tumor. […] Corticotropin-releasing hormone (CRH) stimulation test: In this test, youre given a shot of CRH. This will raise levels of ACTH and cortisol in people with pituitary tumors. […] High dose dexamethasone suppression test: This is the same as the low dose test, except a higher dose of dexamethasone is used. If cortisol levels drop, you may have a pituitary tumor. Higher cortisol levels may indicate an adrenal tumor or ectopic tumor. […] Petrosal sinus sampling: Blood is drawn from a vein near the pituitary and from a vein far from the pituitary. A shot of CRH is given, and if ACTH rises in the blood near the pituitary, it can indicate a pituitary tumor. Similar levels from both samples indicate an ectopic tumor. […] Imaging studies: These may include CT and MRI scans to look for tumors on the adrenal and pituitary glands.

• #18 Azthena logo with the word Azthena

  https://www.news-medical.net/whitepaper/20240524/A-more-accurate-diagnosis-of-Cushinge28099s-syndrome.aspx

  LDDSTs are used initially to diagnose Cushing’s syndrome. If the result is positive, HDDSTs help classify the disease as ACTH-dependent or independent. […] During the LDDST, cortisol levels should decrease following the administration of dexamethasone, and a cut-off value of below 18 ng/mL is recommended to distinguish a healthy response from an unhealthy one. […] For the HDDST, a decrease in urine-free cortisol (UFC) or serum cortisol greater than 50% indicates the presence of ACTH-dependent Cushing’s syndrome. […] A reliable method for reducing the number of false positives in DSTs involves the simultaneous measurement of cortisol and dexamethasone levels, which can be accurately achieved using LC-MS/MS. […] The LC-MS/MS method described in this article enables the simultaneous measurement of multiple analytes, such as cortisol, cortisone, and dexamethasone, in serum or plasma.

• #19 Cushing’s Syndrome: Causes and Treatment | Doctor

  https://patient.info/doctor/cushings-syndrome-pro

  Late-night salivary cortisol measurement is a simple and reliable screening test for Cushing’s syndrome. […] An undetectable plasma ACTH with an elevated serum cortisol level is diagnostic of ACTH-independent Cushing’s syndrome, which is due to a primary cortisol-producing adrenal adenoma or carcinoma, or exogenous glucocorticoid use. […] An elevated ACTH level is consistent with ACTH-dependent Cushing’s syndrome. […] The 8 mg overnight dexamethasone suppression test and the 48-hour high-dose dexamethasone test may be useful when baseline ACTH levels are equivocal. […] A baseline and stimulated ratio of IPS to peripheral ACTH of less than 1.8 is suggestive of ectopic ACTH, while a ratio of IPS to peripheral ACTH of greater than 2 is consistent with a pituitary adenoma.

• #20 Cushing’s Syndrome | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/cushings-syndrome

  24-hour urine collection to measure cortisol levels. […] Once the diagnosis of Cushing’s syndrome is established, the source of the excess cortisol needs to be determined. The source may be from an adrenal gland tumor, ACTH-producing tumor or a pituitary ACTH-producing adenoma. Petrosal sinus sampling is a test used to distinguish the source of the ACTH secretion and should never be performed before the diagnosis of Cushing’s syndrome has been established. […] If laboratory tests suggest a pituitary adenoma as the cause of Cushing’s syndrome, a pituitary magnetic resonance imaging (MRI) is performed to confirm the diagnosis.

• #21 Cushing’s Syndrome/Disease – AANS

  https://www.aans.org/patients/conditions-treatments/cushings-syndrome-disease/

  The late-night salivary cortisol test is a relatively new test that checks for elevated levels of cortisol in the saliva between 11 p.m. and midnight. […] After a definitive diagnosis has been made, the source must then be determined. […] The first step in distinguishing the underlying cause is the measurement of ACTH. […] Performing a high-dose dexamethasone suppression test may be helpful in this situation. […] Despite the tests described above, distinguishing a pituitary from a non-pituitary ACTH-secreting tumor can be diagnostically challenging. […] The following tests are recommended: […] Magnetic Resonance Imaging (MRI) of the pituitary gland with gadolinium enhancement is a recommended approach. […] Petrosal sinus sampling is a test used to distinguish the source of ACTH secretion and should only be performed after the diagnosis of Cushings syndrome has been confirmed.

• #22 Cushing’s Disease Symptoms & Treatment – Pituitary & Skull Base Tumor | UCLA Health

  https://www.uclahealth.org/medical-services/neurosurgery/pituitary-skull-base-tumor/conditions/pituitary-adenomas/cushings-disease

  Cushing’s disease is a serious condition of an excess of the steroid hormone cortisol in the blood level caused by a pituitary tumor secreting adrenocorticotropic hormone (ACTH). […] It can be difficult to diagnosis Cushing’s disease, and the diagnosis is often delayed. An endocrinologist should always supervise the evaluation for Cushing’s disease. […] The early stages of Cushing’s disease may be difficult to recognize, especially because the body changes develop slowly. […] The diagnosis may be difficult to make because sometimes the hormone elevations come and go: so called „cyclic” or „periodic” Cushing’s disease. […] In general, the first step in making the diagnosis is establishing a state of excessive blood cortisol (i.e. Cushing’s syndrome). Assuming cortisol intake is excluded, this typically is done by hormone testing. After this diagnosis is established, an MRI is obtained to determine if a pituitary tumor is visible.

• #23 Dexamethasone Suppression Screening for Cushing Disease/Syndrome | Labcorp

  https://www.labcorp.com/test-menu/resources/dexamethasone-suppression-screening-for-cushing-disease-syndrome

  The Endocrine Society has published guidelines for screening and diagnosis of Cushing disease and Cushing syndrome. […] When clinical signs and symptoms of excess cortisol are present, and exogenous glucocorticoid use has been excluded, screening tests are recommended by the Endocrine Society. […] The single-dose dexamethasone test is used in screening patients suspected of having Cushing disease or Cushing syndrome. […] The single-dose dexamethasone test is valuable in screening for Cushing disease and Cushing syndrome because a normal response showing sufficiently decreased cortisol levels essentially rules out either diagnosis. […] False-positive tests can be seen in patients taking estrogens, obese patients, in those who have had a poor night’s sleep, and in patients under acute emotional or physical stress. […] If a falsely positive result is suspected, the test should be repeated or a different test selected. […] The response to dexamethasone is blunted in pregnancy due to elevated levels of transcortin, but late-night salivary cortisol and UFC are recommended as screening tests.

• #24 Approach to the Patient: Diagnosis of Cushing Syndrome

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9681610/

  Cushing syndrome results from supraphysiological exposure to glucocorticoids and is associated with significant morbidity and mortality. An early diagnosis of Cushing syndrome is warranted; however, in clinical practice, it is very challenging partly because of resemblance with other common conditions (ie, pseudo-Cushing syndrome). Initial workup should start with excluding local and systemic corticosteroid use. First-line screening tests including the 1-mg dexamethasone suppression test, 24-hour urinary free cortisol excretion, and late-night salivary cortisol measurement should be performed to screen for endogenous Cushing syndrome. […] Once endogenous Cushing syndrome is established, measurement of plasma ACTH concentrations differentiates between ACTH-dependent (80%-85%) or ACTH-independent (15%-20%) causes. Further assessment with different imaging modalities and dynamic biochemical testing including bilateral inferior petrosal sinus sampling helps further pinpoint the cause of Cushing syndrome.

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