title: Recommendations of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism for the diagnosis of Cushing's disease in Brazil.
abstract: Although it is a rare condition, the accurate diagnosis and treatment of Cushing's disease is important due to its higher morbidity and mortality compared to the general population, which is attributed to cardiovascular diseases, diabetes mellitus and infections. Screening for hypercortisolism is recommended for patients who present multiple and progressive clinical signs and symptoms, especially those who are considered to be more specific to Cushing's syndrome, abnormal findings relative to age (e.g., spinal osteoporosis and high blood pressure in young patients), weight gain associated with reduced growth rate in the pediatric population and for those with adrenal incidentalomas. Routine screening is not recommended for other groups of patients, such as those with obesity or diabetes mellitus. Magnetic resonance imaging (MRI) of the pituitary, the corticotropin-releasing hormone (CRH) test and the high-dose dexamethasone suppression test are the main tests for the differential diagnosis of ACTH-dependent Cushing's syndrome. Bilateral and simultaneous petrosal sinus sampling is the gold standard method and is performed when the triad of initial tests is inconclusive, doubtful or conflicting. The aim of this article is to provide information on the early detection and establishment of a proper diagnosis of Cushing's disease, recommending follow-up of these patients at experienced referral centers. Arch Endocrinol Metab. 2016;60(3):267-86.
authors.affiliation: Unidade de Neuroendocrinologia, Serviço de Endocrinologia e Metabologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP); Departamento de Endocrinologia, A.C. Camargo Cancer Center, São Paulo, SP, Brasil;
authors.forename: Márcio Carlos
authors.initials: MC
authors.lastname: Machado
authors.affiliation: Unidade de Neuroendocrinologia, Serviço de Endocrinologia e Metabologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP); Departamento de Endocrinologia, A.C. Camargo Cancer Center, São Paulo, SP, Brasil;
authors.forename: Maria Candida Barisson Vilares
authors.initials: MC
authors.lastname: Fragoso
authors.affiliation: Divisão de Endocrinologia e Metabologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brasil;
authors.forename: Ayrton Custódio
authors.initials: AC
authors.lastname: Moreira
authors.affiliation: Serviço de Endocrinologia e Metabologia (SEMPR), Hospital de Clínicas, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brasil;
authors.forename: César Luiz
authors.initials: CL
authors.lastname: Boguszewski
authors.affiliation: Serviço de Endocrinologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (HUCFF/UFRJ), Rio de Janeiro, RJ, Brasil;
authors.forename: Leonardo
authors.initials: L
authors.lastname: Vieira
authors.affiliation: Serviço de Endocrinologia, Hospital Universitário de Brasília, Universidade de Brasília (UnB), Brasília, DF, Brasil;
authors.forename: Luciana A
authors.initials: LA
authors.lastname: Naves
authors.affiliation: Serviço de Endocrinologia, Hospital de Clínicas, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brasil;
authors.forename: Lucio
authors.initials: L
authors.lastname: Vilar
authors.affiliation: Endoville, Joinville, SC, Brasil;
authors.forename: Luiz Antônio de
authors.initials: LA
authors.lastname: Araújo
authors.affiliation: Serviço de Endocrinologia, Hospital de Clínicas de Porto Alegre (HCPA), Faculdade de Medicina da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil;
authors.forename: Mauro A
authors.initials: MA
authors.lastname: Czepielewski
authors.affiliation: Serviço de Endocrinologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (HUCFF/UFRJ), Rio de Janeiro, RJ, Brasil;
authors.forename: Monica R
authors.initials: MR
authors.lastname: Gadelha
authors.affiliation: Unidade de Neuroendocrinologia, Divisão de Neurocirurgia Funcional, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP;Brasil.
authors.forename: Nina Rosa Castro
authors.initials: NR
authors.lastname: Musolino
authors.affiliation: Serviço de Endocrinologia, Santa Casa de Belo Horizonte, Belo Horizonte, MG, Brasil;
authors.forename: Paulo Augusto C
authors.initials: PA
authors.lastname: Miranda
authors.affiliation: Unidade de Neuroendocrinologia, Serviço de Endocrinologia e Metabologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP); Departamento de Endocrinologia, A.C. Camargo Cancer Center, São Paulo, SP, Brasil;
authors.forename: Marcello Delano
authors.initials: MD
authors.lastname: Bronstein
authors.affiliation: Serviço de Endocrinologia, Hospital de Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brasil.
authors.forename: Antônio
authors.initials: A
authors.lastname: Ribeiro-Oliveira
mesh_terms: D049913:ACTH-Secreting Pituitary Adenoma / Q000150:complications / Q000175:diagnosis*; D000236:Adenoma / Q000150:complications / Q000175:diagnosis*; D001938:Brazil; D002851:Chromatography, High Pressure Liquid; D032921:Consensus; D003480:Cushing Syndrome / Q000175:diagnosis* / Q000209:etiology; D003907:Dexamethasone; D003937:Diagnosis, Differential; D005938:Glucocorticoids; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008279:Magnetic Resonance Imaging
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone; D006854:Hydrocortisone