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Establishing the diagnosis of Cushing’s disease is a well recognised challenge when symptoms are subtle and investigations lead to discordant results. Differentiation from pseudo-Cushing’s and other causes of apparent hypercortisolism is not always straightforward1. The Endocrine Society gives clear guidelines on the pathway of investigations of Cushing’s disease2. Many cases present themselves with equivocal findings and attention to detail is necessary in clinical practice to avoid misinterpretation. We present a reminder of the challenges of co-prescribed medications activating CYP3A4 pathway which will interfere with the sequence of investigations for Cushing’s disease.

Limitations of dexamethasone suppression tests for Cushing's disease: a reminder!