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Diagnostic Tests for Cushing's Syndrome
Author(s) -
NIEMAN LYNNETTE K.
Publication year - 2002
Publication title -
annals of the new york academy of sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.712
H-Index - 248
eISSN - 1749-6632
pISSN - 0077-8923
DOI - 10.1111/j.1749-6632.2002.tb04417.x
Subject(s) - medicine , cushing syndrome , dexamethasone suppression test , endocrinology , depression (economics) , population , diabetes mellitus , obesity , weight gain , dexamethasone , body weight , environmental health , economics , macroeconomics
A bstract : The diagnosis of Cushing's syndrome rests on the demonstration of clinical features and biochemical abnormalities that reflect hypercortisolism. If a patient presents with typical clinical features such as weight gain with truncal obesity and supraclavicular fat deposition, wide purple striae, and proximal muscle weakness, the diagnosis is clear‐cut and is nearly always substantiated by a 24‐hour urine free cortisol excretion value more than four times the normal level. However, many patients present with signs and symptoms that are common in the general population, such as hypertension, generalized weight gain, reproductive abnormalities, and depression. Many of these patients have normal cortisol excretion and do not have Cushing's syndrome. Others have mild hypercortisolism caused by psychiatric disorders, obligate exercise, morbid obesity, sleep apnea, or uncontrolled diabetes mellitus. These patients may be confused with those with the true Cushing's syndrome, and thus are considered to have a “pseudo‐Cushing” state. Additional observation over time, and testing with midnight cortisol measurements, the 2‐day‐2‐mg dexamethasone suppression test, or the dexamethasone suppression‐CRH stimulation test may be useful to identify true Cushing's syndrome in these patients.