A Physiologic Approach to Diagnosis of the Cushing Syndrome

  title={A Physiologic Approach to Diagnosis of the Cushing Syndrome},
  author={Hershel Raff and James W. Findling},
  journal={Annals of Internal Medicine},
Clinical Principles* General Obesity Hypertension Metabolic Diabetes mellitus or impaired glucose tolerance Hyperlipidemia Nephrolithiasis Polyuria Skin Plethora Hirsutism Striae Acne Bruising Musculoskeletal Osteopenia or osteoporosis Proximal myopathy Neuropsychiatric Depression Cognitive impairment Emotional lability Euphoria Psychosis Gonadal dysfunction Oligomenorrhea or amenorrhea Impotence, decreased libido Immune suppression (susceptible to opportunistic infection) *Notice that many of… 
Subclinical Hypercortisolism among Outpatients Referred for Osteoporosis
The prevalence of subclinical hypercortisolism among patients with T-scores of 2.5 or less and vertebral fractures was 10.8%, which may be more common than is generally recognized in patients with osteoporosis.
Neoplastic/Pathological and Nonneoplastic/Physiological Hypercortisolism: Cushing Versus Pseudo-Cushing Syndromes
The medical disorders and physiological conditions associated with chronic activation of the hypothalamic–pituitary–adrenal axis are described and a rational clinical and biochemical approach is provided to distinguish them from patients with neoplastic/pathological Cushing syndrome.
Diagnostic approach to Cushing disease.
Patients with repeatedly equivocal results should be reevaluated after several months or undergo a corticotropin-releasing hormone (CRH) stimulation test following low-dose dexamethasone suppression to help rule out pseudo-Cushing states.
The diagnosis of Cushing’s syndrome
Recognition of patients with multiple features, features unusual for their age, patients with features more specific to Cushing’s syndrome, and patients with incidental adrenal mass or polycystic ovary syndrome should prompt an evaluation for cortisol excess.
Subclinical Cushing's syndrome due to unilateral or bilateral adrenal incidentalomas. Problems of diagnostic and indication to surgical treatment. Review of literature
Today subclinical Cushing's syndrome is the most widespread variant of hormonal activity of incidentaloma's hormonal activity. This pathology is defined as a mild intensity autonomous cortisol
Midnight serum cortisol as a marker of increased cardiovascular risk in patients with a clinically inapparent adrenal adenoma.
Elevated midnight cortisol concentration is a reliable test to select a subgroup of patients with a clinically inapparent adrenal adenoma with an adverse cardiovascular risk profile and any correlation between endocrine data and clinical phenotype exists is examined.
Differentiation of pathologic/neoplastic hypercortisolism (Cushing syndrome) from physiologic/non-neoplastic hypercortisolism (formerly known as Pseudo-Cushing syndrome): response to Letter to the Editor.
This review will define and characterize the numerous causes of physiologic/non-neoplastic hypercortisolism and provide a rational clinical and biochemical approach to distinguish it from pathologic/neoplastics hypercortsisolism (true Cushing syndrome).
Cushing's syndrome: from physiological principles to diagnosis and clinical care
Understanding basic physiology informs the development of new approaches to diagnosis and treatment of Cushing's syndrome, and appreciating pathophysiology generates new areas for inquiry of basic physiological and biochemical mechanisms.
Etomidate Use for Cushing's Syndrome Caused by an Ectopic Adrenocorticotropic Hormone–Producing Tumor
When oral or enteral medications cannot be administered and sedation is required in critically ill patients, etomidate is an appropriate intravenous agent for hypercortisolemia.
The diagnosis and differential diagnosis of endogenous Cushing's syndrome.
This review will discuss the various causes of endogenous CS and focus on established and evolving diagnostic procedures used for its diagnosis, as several studies with large number of patients have recently appeared in the literature validating current practice and proposing improved diagnostic algorithms.


Absence of Cushingoid phenotype in a patient with Cushing's disease due to defective cortisone to cortisol conversion.
A case of Cushing's disease that failed to present with a classical phenotype is described, and it is postulate that this is due to a partial defect of 11beta-HSD1 activity, the defect in cortisone to cortisol conversion increasing cortisol clearance and thus protecting the patient from the effects of cortisol excess.
Adrenal incidentaloma: a new cause of the metabolic syndrome?
Many patients with incidental adrenal adenoma display altered glucose tolerance, that may be explained by reduced insulin sensitivity, and increased blood pressure levels in comparison with carefully age- and BMI-matched controls.
Ectopic and abnormal hormone receptors in adrenal Cushing's syndrome.
The mechanism by which cortisol is produced in adrenal Cushing's syndrome, when ACTH is suppressed, was previously unknown and was referred to as being "autonomous." More recently, several
Neuropsychiatric manifestations of patients with Cushing's syndrome. Relationship to cortisol and adrenocorticotropic hormone levels.
A statistically significant relationship was found between the overall neuropsychiatric disability rating and cortisol and adrenocorticotropic hormone (ACTH) levels.
Preclinical Cushing's syndrome in adrenal "incidentalomas": comparison with adrenal Cushing's syndrome.
Patients with asymptomatic adrenal incidentalomas, therefore, should be screened for cortisol production by means of an overnight dexamethasone suppression test, as it is more frequently observed than previously assumed.
Diagnosis and differential diagnosis of Cushing's syndrome.
  • J. Findling, H. Raff
  • Medicine, Biology
    Endocrinology and metabolism clinics of North America
  • 2001
Detección de sindrome de Cushing preclinico en pacientes con sobrepeso y diabetes mellitus tipo 2
In a DM female an elevated UF and Spot F associated to absence of cortisol inhibition to the overnight 1 mg dexamethasone suppression test was repeatedly detected, and it would be useful to screen DM patients with poor glycemic control for PCS.
Factitious Cushing syndrome.
Factitious Cushing syndrome is a difficult diagnosis and high pressure liquid chromatography analysis of urine steroids, the most definitive test for the factitious disorder, should be performed whenever there is clinical suspicion of glucocorticoid abuse.
Steroid hormones and hypertension: The cortisol-cortisone shuttle
Evaluation of the hypothalamic hypophyseal adrenal axis in patients receiving long-term hemodialysis.
There is a problem of gastrointestinal absorption producing the abnormal dexamethasone suppression test in patients with renal failure, and there are concerns about the half-life of the drug.