RT Journal Article
SR Electronic
T1 Cushing's syndrome: a practical approach to diagnosis and differential diagnoses
JF Journal of Clinical Pathology
JO J Clin Pathol
FD BMJ Publishing Group Ltd and Association of Clinical Pathologists
SP 350
OP 359
DO 10.1136/jclinpath-2016-203933
VO 70
IS 4
A1 Joseph M Pappachan
A1 Christian Hariman
A1 Mahamood Edavalath
A1 Julian Waldron
A1 Fahmy W Hanna
YR 2017
UL http://jcp.bmj.com/content/70/4/350.abstract
AB 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 48 hours. 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. This best practice review discusses a practical approach for the diagnostic evaluation of CS with a brief discussion on differential diagnoses, and cyclical CS, to enhance the skills of clinicians and laboratory personnel.