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Diagnosis and differential diagnosis of Cushing's syndrome. Endocrinol Metab Clin North Am 2001 Sep;30(3):729-47

Date

09/27/2001

Pubmed ID

11571938

DOI

10.1016/s0889-8529(05)70209-7

Scopus ID

2-s2.0-0034842879   103 Citations

Abstract

The clinical recognition of Cushing's syndrome and its biochemical confirmation is a challenging problem. The best diagnostic approach to patients with suspected Cushing's syndrome is still evolving. The traditional diagnostic approach of urine free cortisol and low-dose dexamethasone suppression testing may be inadequate when the degree of hypercortisolism is mild. Late-night salivary cortisol determinations may evolve as the simplest means of screening patients for suspected hypercortisolism. Repeated measurements of cortisol secretion (urine free cortisol or late-night salivary cortisol) over an extended period of time may be necessary to provide diagnostic certainty. The dexamethasone-CRH test is a reasonable approach in patients with equivocal data. The introduction of reliable, sensitive, and specific plasma ACTH measurements, the use of IPSS for ACTH with CRH stimulation, and the improved techniques of pituitary and adrenal imaging have made the differential diagnosis of Cushing's syndrome relatively straightforward (see Fig. 2). Clinicians who have never missed the diagnosis of Cushing's syndrome or have never been fooled by attempting to establish its cause should refer their patients with suspected hypercortisolism to someone who has.

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

Cushing Syndrome
Diagnosis, Differential
Hormones
Humans
Magnetic Resonance Imaging
Microvascular Angina
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