Cushing’s Syndrome. Issues in diagnosis. Overview of presentation. Introduction to CS How is CS diagnosed? What are the main problems surrounding diagnosis? Psychological implications and patient perspective Conclusion. What is Cushing’s syndrome?.
Issues in diagnosis
- Pts with ectopic ACTH production may show biological characteristics similar to those with pituitary-dependent Cushing’s syndrome.
- Need to be ruled out by clinician in borderline cases.
Screening - Standard overnight dexamethasone suppression test
24 urinary cortisol
Confirming - 48 hour dexamethasone suppression test
Defining the - Basal ACTH,
Aetiology ACTH independent – HDDST/ Adrenal Imaging
ACTH dependent - CRH stimulation test/ Inferior
petrosal sinus sampling/ Pituitary imaging
24 hour urinary free cortisol
(Barrout et Al. ).
Disadvantages to test
Overnight dexamethasone suppression test
HIGH DOSE DEXAMETHASONE SUPPRESSION TEST (HDDST)
ACTH DEPENDENT CS
(1) CRH STIMULATION TEST
(2) INFERIOR PETROSAL SINUS SAMPLING
(3) PITUITARY IMAGING
PSYCHIATRIC FEATURES ASSCOCIATED WITH CS