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Perspectives

Cushing’s syndrome versus simple obesity: how can a needle be found in the haystack?

Manodhi Saranapala, David J Torpy

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Abstract

Clinical recognition of Cushing’s syndrome should generally follow from the observation of a constellation of compatible clinical features that progress over time. Screening for Cushing’s syndrome in patients with individual features of the metabolic syndrome, such as obesity, hypertension and hyperglycaemia, is not recommended. Early diagnosis reduces unnecessary suffering and the ultimate lifetime sequelae of Cushing’s syndrome. Confirmation involves the demonstration of biochemical hypercortisolism, and the extent of diagnostic testing needs to be based on the degree of clinical suspicion.

Key Points

  • A diagnosis of Cushing’s syndrome depends on the recognition of a constellation of compatible clinical features that progress over time.
  • The tests for confirmation of hypercortisolism are the 24-hour urine free cortisol test, 1 mg overnight dexamethasone suppression test and the late night salivary cortisol test. All three tests may have false-negative and false-positive results, and results close to laboratory normal cut-offs should be regarded as nondefinitive.
  • The extent of testing for hypercortisolism depends on the degree of clinical suspicion and the results of initial testing.

    Picture credit: © lom123/Dollar Photo Club.

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