Diagnosis and Differential Diagnosis of Cushing’s Syndrome

Loriaux, D. Lynn

doi:10.1056/nejmra1505550

Cited by 97 publications

(61 citation statements)

References 23 publications

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“…Screening for CS diagnosis in patients with obesity, should be carried out in subjects who exhibit specific clinical features suggestive of hypercortisolism. In this context, catabolic signs such as skin atrophy, osteoporosis, spontaneous ecchymoses, proximal myopathy or wide purple striae increase the likelihood of CS (77,78,88). The combination of some catabolic manifestations such as osteoporosis, spontaneous ecchymoses and thin skin is associated with a 95% probability of a diagnosis of CS (88).…”

Section: Reasoningmentioning

confidence: 99%

“…In this context, catabolic signs such as skin atrophy, osteoporosis, spontaneous ecchymoses, proximal myopathy or wide purple striae increase the likelihood of CS (77,78,88). The combination of some catabolic manifestations such as osteoporosis, spontaneous ecchymoses and thin skin is associated with a 95% probability of a diagnosis of CS (88). Other features such as central obesity, type 2 diabetes, hypertension or depression appear in CS but also are common in obesity (Table 4).…”

Section: Reasoningmentioning

confidence: 99%

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European Society of Endocrinology Clinical Practice Guideline: Endocrine work-up in obesity

Pasquali

Casanueva

Haluzı́k

et al. 2020

European Journal of Endocrinology

135

156

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Obesity is an emerging condition, with a prevalence of ~20%. Although the simple measurement of BMI is likely a simplistic approach to obesity, BMI is easily calculated, and there are currently no data showing that more sophisticated methods are more useful to guide the endocrine work-up in obesity. An increased BMI leads to a number of hormonal changes. Additionally, concomitant hormonal diseases can be present in obesity and have to be properly diagnosed – which in turn might be more difficult due to alterations caused by body fatness itself. The present European Society of Endocrinology Clinical Guideline on the Endocrine Work-up in Obesity acknowledges the increased prevalence of many endocrine conditions in obesity. It is recommended to test all patients with obesity for thyroid function, given the high prevalence of hypothyroidism in obesity. For hypercortisolism, male hypogonadism and female gonadal dysfunction, hormonal testing is only recommended if case of clinical suspicion of an underlying endocrine disorder. The guideline underlines that weight loss in obesity should be emphasized as key to restoration of hormonal imbalances and that treatment and that the effect of treating endocrine disorders on weight loss is only modest.

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Section: Reasoningmentioning

confidence: 99%

Section: Reasoningmentioning

confidence: 99%

European Society of Endocrinology Clinical Practice Guideline: Endocrine work-up in obesity

Pasquali

Casanueva

Haluzı́k

et al. 2020

European Journal of Endocrinology

135

156

View full text Add to dashboard Cite

show abstract

“…The clinical features of pseudo-CS may overlap with CS and also give false positive test results, and so clinicians must be aware to this fact during screening [ 1 , 2 , 9 ]. The rising worldwide prevalence of obesity and clinical features of obesity-related metabolic syndrome typify such overlaps in clinical features as well as difficulties with biochemical diagnosis [ 10 , 11 ].…”

Section: Clinical Presentationmentioning

confidence: 99%

Screening for Cushing Syndrome at the Primary Care Level: What Every General Practitioner Must Know

Yorke

Atiase

Akpalu

et al. 2017

International Journal of Endocrinology

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Cushing's syndrome is a rare entity, and a high index of suspicion is needed for screening in a primary care setting. The clinical awareness of the primary care physician (PCP) to the highly indicative signs and symptoms such as facial plethora, proximal myopathy, reddish purple striae, and easy bruisability should alert him to look for biochemical evidence of Cushing's syndrome through any of the first-line screening tests, namely, 24-hour urinary free cortisol, overnight dexamethasone suppression test, or late-night salivary cortisol. Commonly used random cortisol measurements are unreliable; hence, general practitioners are encouraged to understand the use of these more reliable tests with increased sensitivity and specificity for screening Cushing's syndrome. In this write-up, we set out to increase awareness about the presentation of Cushing's syndrome and current recommended screening methods as well as their strengths and weaknesses. We relied mainly on the recommendations by the Endocrine Society Guidelines.

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“…Clinical presentation of CD is variable, ranging from mild or subclinical hypercortisolism to moderate or severe hypercortisolism [11]. Three biochemical tests -urinary free cortisol (UFC), plasma cortisol after dexamethasone and/or late night salivary cortisol are needed to distinguish patients with Cushing's syndrome (CS) from those with obesity or metabolic syndrome [12]. Recurrent infections and osteopenia have been reported to be the most discriminant symptoms between obesity or diabetes mellitus and CS [13].…”

Section: Introductionmentioning

confidence: 99%

“The Adrenal Gland: Central Relay in Health and Disease - Current Challenges and Perspectives 2018” – Cushing’s Disease

Stalla

Ciato

Dimopoulou

2018

Exp Clin Endocrinol Diabetes

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CD is associated to a significant clinical burden, since numerous comorbidities persist after long-term biochemical control. These chronically ill patients show an increased mortality despite disease remission. Clinicians should treat comorbidities aggressively and seek for appropriate consultations. Structured consultation hours and expert excellence networks are needed in order to allow optimal, individualized care for affected patients, reverse increased morbidity and mortality and identify tumor recurrence early.

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Diagnosis and Differential Diagnosis of Cushing’s Syndrome

Cited by 97 publications

References 23 publications

European Society of Endocrinology Clinical Practice Guideline: Endocrine work-up in obesity

European Society of Endocrinology Clinical Practice Guideline: Endocrine work-up in obesity

Screening for Cushing Syndrome at the Primary Care Level: What Every General Practitioner Must Know

“The Adrenal Gland: Central Relay in Health and Disease - Current Challenges and Perspectives 2018” – Cushing’s Disease

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