The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline.
OBJECTIVE
The objective of the study was to develop clinical practice guidelines for the diagnosis of Cushing's syndrome.


METHODS
The Task Force included a chair, selected by the Clinical Guidelines Subcommittee (CGS) of The Endocrine Society, five additional experts, a methodologist, and a medical writer. The Task Force received no corporate funding or remuneration.


METHODS
Consensus was guided by systematic reviews of evidence and discussions. The guidelines were reviewed and approved sequentially by The Endocrine Society's CGS and Clinical Affairs Core Committee, members responding to a web posting, and The Endocrine Society Council. At each stage the Task Force incorporated needed changes in response to written comments.


CONCLUSIONS
After excluding exogenous glucocorticoid use, we recommend testing for Cushing's syndrome in patients with multiple and progressive features compatible with the syndrome, particularly those with a high discriminatory value, and patients with adrenal incidentaloma. We recommend initial use of one test with high diagnostic accuracy (urine cortisol, late night salivary cortisol, 1 mg overnight or 2 mg 48-h dexamethasone suppression test). We recommend that patients with an abnormal result see an endocrinologist and undergo a second test, either one of the above or, in some cases, a serum midnight cortisol or dexamethasone-CRH test. Patients with concordant abnormal results should undergo testing for the cause of Cushing's syndrome. Patients with concordant normal results should not undergo further evaluation. We recommend additional testing in patients with discordant results, normal responses suspected of cyclic hypercortisolism, or initially normal responses who accumulate additional features over time.
Nieman
Lynnette K
LK
Program on Reproductive and Adult Endocrinology, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA. govt-prof@endo.society.org
Biller
Beverly M K
BM
Findling
James W
JW
Newell-Price
John
J
Savage
Martin O
MO
Stewart
Paul M
PM
Montori
Victor M
VM
D003480:Cushing Syndrome / Q000175:diagnosis* / Q000401:mortality; D003907:Dexamethasone / Q000378:metabolism; D019317:Evidence-Based Medicine; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis / Q000097:blood / Q000652:urine; D012463:Saliva / Q000737:chemistry
D003907:Dexamethasone; D006854:Hydrocortisone