Cushing’s Syndrome: Important Issues in Diagnosis and Management
Open Access
- 1 October 2006
- journal article
- review article
- Published by The Endocrine Society in Journal of Clinical Endocrinology & Metabolism
- Vol. 91 (10), 3746-3753
- https://doi.org/10.1210/jc.2006-0997
Abstract
Context: The diagnosis, differential diagnosis, and treatment of Cushing’s syndrome are challenging problems in clinical endocrinology. We focus on critical questions addressing screening for Cushing’s syndrome, differentiation of Cushing’s subtypes, and treatment options. Evidence Acquisition: Ovid’s MEDLINE (1996 through April 2006) was used to search the general literature. We also relied on previously published reviews and a recent monograph and cite a mix of primary articles and recent reviews. Evidence Synthesis: Although this article represents our opinion, it draws heavily on a recent consensus statement from experts in the field and a recent monograph on Cushing’s syndrome. Conclusions: We concluded that: 1) measurement of late-night or bedtime salivary cortisol is a useful approach to screen for Cushing’s syndrome; 2) measurement of suppressed plasma ACTH by immunometric assay is useful to differentiate ACTH-dependent and -independent Cushing’s syndrome; 3) inferior petrosal sinus sampling for ACTH should be performed in patients with ACTH-dependent hypercortisolism in whom a pituitary magnetic resonance imaging is normal or equivocal (in the absence of a pituitary ACTH gradient, prolactin levels should be measured to confirm the integrity of venous sampling); 4) computed tomography of the chest and abdomen and somatostatin receptor scintigraphy should be performed in patients with the occult ectopic ACTH syndrome; and 5) patients with Cushing’s disease should be referred to a neurosurgeon with extensive experience operating on corticotroph microadenomas. Bilateral laparoscopic adrenalectomy should be considered in patients with Cushing’s disease who fail therapies directed at the pituitary.Keywords
This publication has 73 references indexed in Scilit:
- Cushing's syndromeThe Lancet, 2006
- The Ectopic Adrenocorticotropin Syndrome: Clinical Features, Diagnosis, Management, and Long-Term Follow-UpJournal of Clinical Endocrinology & Metabolism, 2006
- Difficulties in Excluding Cushing Syndrome in Obese SubjectsThe Endocrinologist, 2006
- Cognitive Function and Cerebral Assessment in Patients Who Have Cushing's SyndromeEndocrinology and Metabolism Clinics of North America, 2005
- Exogenous Cushing's Syndrome and Glucocorticoid WithdrawalEndocrinology and Metabolism Clinics of North America, 2005
- Screening and Diagnosis of Cushing's SyndromeEndocrinology and Metabolism Clinics of North America, 2005
- Diagnosis and Complications of Cushing’s Syndrome: A Consensus StatementJournal of Clinical Endocrinology & Metabolism, 2003
- A Physiologic Approach to Diagnosis of the Cushing SyndromeAnnals of Internal Medicine, 2003
- Psychopathology in patients with endogenous Cushing's syndrome: ‘atypical’ or melancholic featuresClinical Endocrinology, 1995
- The role of glucocorticoids in the regulation of growth hormone secretion Mechanisms and clinical significanceTrends in Endocrinology & Metabolism, 1992