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Newer diagnostic techniques and problems in Cushing's disease. Endocrinol Metab Clin North Am 1999 Mar;28(1):191-210

Date

04/20/1999

Pubmed ID

10207691

DOI

10.1016/s0889-8529(05)70063-3

Scopus ID

2-s2.0-0032912144   62 Citations

Abstract

The best diagnostic approach to patients with suspected Cushing's disease continues to evolve. The introduction of transsphenoidal pituitary surgery as the treatment of choice for Cushing's disease as well as the absence of any pituitary imaging abnormalities in many patients with Cushing's disease has made accurate diagnosis and differential diagnosis essential. In the authors' opinion, two or three late night (11 PM) salivary cortisol determinations and the measurement of 24-hour UFC are the best and simplest means to evaluate patients with suspected hypercortisolism. L-DST can no longer be recommended to exclude the diagnosis of Cushing's disease, particularly if the hypercortisolism is mild. The combination of L-DST and CRH stimulation is a new and apparently sensitive means to establish the presence or absence of pathologic hypercortisolism in equivocal cases. In the absence of an overt pituitary tumor on MR imaging, inferior petrosal sinus sampling with CRH stimulation should be performed to secure the diagnosis of Cushing's disease as well as identify the probable location of the corticotroph adenoma.

Author List

Findling JW, Raff H

Authors

James W. Findling MD Staff Physician in the Multi-Specialty department at Medical College of Wisconsin
Hershel Raff PhD Professor in the Medicine department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adrenocorticotropic Hormone
Circadian Rhythm
Corticotropin-Releasing Hormone
Cushing Syndrome
Deamino Arginine Vasopressin
Dexamethasone
Diagnosis, Differential
Glucocorticoids
Humans
Hydrocortisone
Saliva
jenkins-FCD Prod-484 8aa07fc50b7f6d102f3dda2f4c7056ff84294d1d