Laboratory Studies

The diagnosis of Cushing syndrome requires the demonstration of an 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:^{[2, 3]}

Midnight serum or salivary cortisol^{[4, 5, 6]}
24-hour urine free cortisol
Low-dose dexamethasone suppression test (Liddle test)

An adrenocorticotropic hormone (ACTH) level obtained at the same time as the cortisol level can be helpful in identifying the etiology of Cushing syndrome.

Diagnosis of Cushing syndrome.

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Other Tests

A study by Álvarez-Hernández et al indicated that the clinical severity index of Cushing syndrome, developed by Sonino et al, while useful in endogenous Cushing syndrome, can also effectively be employed in patients with the iatrogenic form of the condition (specifically, in this report, those who had undergone at least 4 weeks of glucocorticoid treatment for rheumatologic disease). Once the definitions of subjective clinical variables had been standardized, the investigators found that the index adequately correlated with clinical manifestations associated with chronic glucocorticoid use.^[33]

Treatment & Management

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Jonat C, Rahmsdorf HJ, Park KK, Cato AC, Gebel S, Ponta H, et al. Antitumor promotion and antiinflammation: down-modulation of AP-1 (Fos/Jun) activity by glucocorticoid hormone. Cell. 1990 Sep 21. 62(6):1189-204. [QxMD MEDLINE Link].
Serfling G, Buades-Rotger M, Harbeck B, Kramer UM, Brabant G. The corticosteroid prednisolone increases amygdala and insula reactivity to food approach signals in healthy young men. Psychoneuroendocrinology. 2018 Sep 8. 99:154-65. [QxMD MEDLINE Link].
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Dutta D, Shivaprasad KS, Ghosh S, Mukhopadhyay S, Chowdhury S. Iatrogenic Cushing's syndrome following short-term intranasal steroid use. J Clin Res Pediatr Endocrinol. 2012 Sep. 4(3):157-9. [QxMD MEDLINE Link]. [Full Text].
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Media Gallery

Physical findings in Cushing syndrome.
Diagnosis of Cushing syndrome.

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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 Associate Professor of Medicine, The Steven, Daniel and Douglas Altman Chair of Endocrinology, Sidney Kimmel Medical College of Thomas Jefferson University; Einstein Endocrine Associates, 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

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 (Retired) Professor, Division of Endocrinology, Diabetes and Metabolism, 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

Sections Iatrogenic Cushing Syndrome
Overview
Presentation
- History
- Physical
- Causes
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DDx
Workup
Treatment
Follow-up
Questions & Answers
Media Gallery
Tables
References

Type	Drug	Dose	Relative Glucocorticoid Potency	Relative Mineralocorticoid Potency	Plasma Half-Life (mg)	Biologic Half-Life (h)
Short-acting	Cortisol	20	1.0	2	90	8-12
Short-acting	Hydrocortisone^‡	25	0.8	2	80-118	8-12
Intermediate-acting	Prednisone	5	4	1	60	18-36
	Prednisolone	5	4	1	115-200	18-36
	Triamcinolone	4	5	0	30	18-36
	Methylprednisolone	4	5	0	180	18-36
Long-acting	Dexamethasone	0.5	25-50	0	200	36-54
Long-acting	Betamethasone	0.6	25-50	0	300	36-54
Mineralocorticoid	Aldosterone	0.3	0	300	15-20	8-12
	Fludrocortisone	2	15	150	200	18-36
	Desoxycorticosterone acetate	0	0	20	70	…

Iatrogenic Cushing Syndrome Workup

Laboratory Studies

Other Tests

References

Tables

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