How to Diagnose Cushing's Syndrome
Cushing's syndrome is a disorder caused by excess secretion of cortisol. It may be caused by adrenocortical hyperplasia, a tumor that secretes adrenocorticotropic hormone or steroid abuse. The majority of cases in the United States are caused by glucocorticoids being administered for the purpose of performance enhancement in sports, especially bodybuilding. Cushing's syndrome is called Cushing disease when it is caused by an adenoma that secretes adrenocorticotropic hormone.
- Difficulty:
- Challenging
Instructions
-
-
1
Obtain the patient history. The most common complaint with Cushing syndrome is weight gain, especially in the upper body and face. This condition is also associated with thinning of the skin, causing easy bruising and purple stretch marks.
-
2
Examine the patient's obesity clinically. The increased adipose tissue in the face and upper back behind the neck is characteristic, as are the fat pads above the clavicles. Adipose tissue typically makes the waist to hip ratio greater than 1 in men and greater than 0.8 in women.
-
3
Differentiate Cushing syndrome from other similar conditions. The primary difference between Cushing syndrome and pseudo-Cushing syndromes is that the features of Cushing syndrome do not disappear when the primary cause is resolved.
-
4
Confirm the diagnosis by demonstrating elevated levels of serum or urine cortisol levels. Four acceptable methods are available for accomplishing this: a low-dose dexamethasone suppression test, a dexamethasone-corticotrophin releasing hormone test, a urinary free cortisol test and an evening salivary and serum cortisol level.
-
5
Perform a Computed Tomography (CT) scan primarily to eliminate the possibility of an adrenal carcinoma.
-
1
