Diagnosis of Cushing's syndrome
Seek Expert Advice.
Who should be tested
Testing for Cushing's syndrome is recommended in the following groups (1):
Features that best discriminate Cushing's syndrome; most do not have a high sensitivity | ||
easy bruising | ||
facial plethora | ||
proximal myopathy (or proximal muscle weakness) | ||
striae (especially if reddish purple and > 1 cm wide) | ||
on children, weight gain with decreasing growth velocity |
Cushing's syndrome features in the general population that are common and/or less discriminatory | ||
depression | dorsocervical fat pad ("buffalo hump") | |
fatigue | facial fullness | |
weight gain | obesity | |
back pain | supraclavicular fullness | |
changes in appetite | thin skin | |
decreased concentration | peripheral edema | |
decreased libido | acne | |
impaired memory (especially short term) | hirsutism or female balding | |
insomnia | poor skin healing | |
irritability | ||
menstrual abnormalities | ||
in children, slow growth | in children, abnormal genital virilization | |
in children, short stature | ||
in children, pseudoprecocious puberty or delayed puberty |
The following tests are advised NOT to be used to test for Cushing's syndrome (1)
For the initial testing for Cushing's syndrome, one of the following tests based on its suitability for a given patient, is recommended (1):
Diagnostic criteria that suggest Cushing's syndrome are UFC greater than the normal range for the assay, serum cortisol greater than 1.8 mug/dl (50 nmol/liter) after 1 mg dexamethasone (1-mg DST), and late-night salivary cortisol greater than 145 ng/dl (4 nmol/liter).
Subsequent evaluation based on expert advice
Reference:
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