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Cushing Syndrome Diagnostic Workup

Diagnostic evaluation of chronic cortisol excess.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Internal Medicine department. Book Appointment →

What is Cushing Syndrome Diagnostic Workup?

Cushing syndrome is the totality of characteristic clinical and metabolic findings caused by chronic cortisol excess. The most common cause is exogenous glucocorticoid use (iatrogenic). Endogenous causes are classified as ACTH-dependent (80-85%, pituitary adenoma=Cushing disease or ectopic ACTH) and ACTH-independent (15-20%, adrenal adenoma/carcinoma).

The diagnostic workup consists of three steps: (1) confirmation of Cushing syndrome (24-hour free cortisol, late-night salivary cortisol, 1 mg dexamethasone suppression test), (2) ACTH-dependent/independent differentiation, (3) source identification (pituitary MRI, CT, inferior petrosal sinus sampling).

If untreated, it leads to significant morbidity and mortality. Osteoporosis, diabetes, hypertension, susceptibility to infection, and psychiatric disorders are the main complications.

Symptoms

Central obesity (face and trunk fat with thin extremities)
Moon face
Dark purple-red striae (abdomen, thighs)
Proximal muscle weakness
Easy bruising and skin thinning
Hypertension and hyperglycemia

Risk Factors

Long-term glucocorticoid use
Pituitary adenoma (Cushing disease)
Adrenal adenoma or carcinoma
Ectopic ACTH-secreting tumors (small-cell lung cancer)
Female sex (3-8 fold higher in Cushing disease)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • If purple striae develop with central obesity
  • If proximal muscle weakness and easy bruising are present
  • If new diabetes, hypertension, and osteoporosis are detected together
  • If Cushing features develop in a patient on long-term steroid therapy

Treatment Methods

01
Cushing disease: transsphenoidal pituitary surgery
02
Adrenal adenoma: adrenalectomy
03
Ectopic ACTH: treatment of the primary tumor
04
Iatrogenic: gradual tapering of the glucocorticoid
05
Medical therapy: ketoconazole, metyrapone, osilodrostat (preoperatively or in refractory cases)

Which Department to Visit?

You can visit our Endokrinoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.