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Iatrogenic Cushing Syndrome Workup

  • Author: Ha Cam Thuy Nguyen, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
 
Updated: Jul 20, 2016
 

Laboratory Studies

The diagnosis of Cushing syndrome requires demonstration of inappropriately high level of cortisol in the serum or urine. The levels should be measured when cortisol, according to its physiologic circadian rhythm, is supposed to be suppressed, meaning at midnight or when a patient is given exogenous glucocorticoids.

This concept gives rise to the following tests, which have been recommended as screening tests for Cushing syndrome:[22, 23]

  • Midnight serum or salivary cortisol[24, 25, 26]
  • 24-hour urine free cortisol
  • Low dose dexamethasone suppression test (Liddle test).

An ACTH level obtained at the same time with cortisol level can be helpful in identifying the etiology of Cushing syndrome.

Diagnosis of Cushing syndrome. Diagnosis of Cushing syndrome.
 
 
Contributor Information and Disclosures
Author

Ha Cam Thuy Nguyen, MD Fellow, Department of Endocrinology, University of Pittsburgh Medical Center

Ha Cam Thuy Nguyen, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, American Medical Association, Endocrine Society

Disclosure: Nothing to disclose.

Coauthor(s)

Catherine Anastasopoulou, MD, PhD, FACE Assistant Professor of Medicine, Jefferson Medical College of Thomas Jefferson University; Attending Endocrinologist, Department of Medicine, Albert Einstein Medical Center

Catherine Anastasopoulou, MD, PhD, FACE is a member of the following medical societies: American Association of Clinical Endocrinologists, American Society for Bone and Mineral Research, Endocrine Society, Philadelphia Endocrine Society, National Osteoporosis Foundation

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Romesh Khardori, MD, PhD, FACP Professor of Endocrinology, Director of Training Program, Division of Endocrinology, Diabetes and Metabolism, Strelitz Diabetes and Endocrine Disorders Institute, Department of Internal Medicine, Eastern Virginia Medical School

Romesh Khardori, MD, PhD, FACP is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, American Diabetes Association, Endocrine Society

Disclosure: Nothing to disclose.

Acknowledgements

Gail K Adler, MD, PhD, Associate Professor of Medicine, Department of Medicine, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School.

Disclosure: Nothing to disclose.

Susanna L Dipp, MD Fellow, Department of Medicine, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School

Disclosure: Nothing to disclose

Don S Schalch, MD Professor Emeritus, Department of Internal Medicine, Division of Endocrinology, University of Wisconsin Hospitals and Clinics

Don S Schalch, MD is a member of the following medical societies: American Diabetes Association, American Federation for Medical Research, Central Society for Clinical Research, and Endocrine Society

Disclosure: Nothing to disclose

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Physical findings in Cushing syndrome.
Diagnosis of Cushing syndrome.
Table 1. Glucocorticoid Equivalencies[5]
TypeDrugDoseRelative Glucocorticoid PotencyRelative Mineralocorticoid PotencyPlasma Half-Life



(mg)



Biologic Half-Life



(h)



Short-actingCortisol201.02908-12
Hydrocortisone250.8280-1188-12
Intermediate-actingPrednisone5416018-36
Prednisolone541115-20018-36
Triamcinolone4503018-36
Methylprednisolone45018018-36
Long-actingDexamethasone0.525-50020036-54
Betamethasone0.625-50030036-54
MineralocorticoidAldosterone0.3030015-208-12
Fludrocortisone21515020018-36
Desoxycorticosterone acetate002070
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