title: [Endogenous Cushing's syndrome].
abstract: BACKGROUND
  Untreated endogenous Cushing's syndrome is a serious condition with high morbidity and mortality. New diagnostic procedures make today's assessment more accurate. We describe which tests should be done when there is suspicion of the syndrome. Treatment options are mentioned.
  
  
  METHODS
  The paper is based on current international literature and reflects the experience of the authors.
  
  
  CONCLUSIONS
  Endogenous Cushing's syndrome is caused by elevated cortisol levels. The reason can be overproduction of ACTH or an adrenocortical pathology. It should be considered when combinations of symptoms like central obesity, proximal muscle weakness, striae and menstrual irregularities are seen. Osteoporosis and impotence are other important symptoms. Diagnosis of Cushing's syndrome is often challenging. Measurement of urinary free cortisol or overnight dexamethasone suppression test has usually been performed initially. Midnight salivary cortisol seems promising as an alternative. The final diagnosis is often made after a combined evaluation of dynamic tests. The first-line treatment of endogenous Cushing's syndrome is surgery.
authors.affiliation: Endokrinologisk seksjon, Medisinsk avdeling, Rikshospitalet, 0027 Oslo. johan.arild.evang@rikshospitalet.no
authors.forename: Johan Arild
authors.initials: JA
authors.lastname: Evang
authors.forename: Sven M
authors.initials: SM
authors.lastname: Carlsen
authors.forename: Johan
authors.initials: J
authors.lastname: Svartberg
authors.forename: Sylvi
authors.initials: S
authors.lastname: Aanderud
authors.forename: Øivind
authors.initials: Ø
authors.lastname: Johannesen
authors.forename: Thomas
authors.initials: T
authors.lastname: Schreiner
authors.forename: Jon
authors.initials: J
authors.lastname: Ramm-Pettersen
authors.forename: Søren Jacob
authors.initials: SJ
authors.lastname: Bakke
authors.forename: Morten
authors.initials: M
authors.lastname: Lund-Johansen
authors.forename: Jens
authors.initials: J
authors.lastname: Bollerslev
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood; D014408:Biomarkers, Tumor / Q000097:blood; D053379:Chromogranin A; D002864:Chromogranins / Q000097:blood; D002940:Circadian Rhythm; D003480:Cushing Syndrome / Q000175:diagnosis* / Q000601:surgery; D003937:Diagnosis, Differential; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis; D010902:Pituitary Gland / Q000473:pathology; D012463:Saliva / Q000737:chemistry
chemical_list: D014408:Biomarkers, Tumor; D053379:Chromogranin A; D002864:Chromogranins; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone