The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline.
By L. Nieman, B. Biller, J. Findling, J. Newell-Price, M. Savage, P. Stewart, Victor M. Montori. Journal of Clinical Endocrinology and Metabolism, 2008
2,473 citations recorded by the source corpus.
OBJECTIVE The objective of the study was to develop clinical practice guidelines for the diagnosis of Cushing's syndrome. PARTICIPANTS The Task Force included a chair, selected by the Clinical Guidelines Subcommittee (CGS) of The Endocrine Society, five additional experts, a methodologist, and a medical writer. The Task Force received no corporate funding or remuneration. CONSENSUS PROCESS Consensus was guided by systematic reviews of evidence and discussions. The guidelines were reviewed and approved sequentially by The Endocrine Society's CGS and Clinical Affairs Core Committee, members responding to a web posting, and The Endocrine Society Council. At each stage the Task Force incorporated needed changes in response to written comments. CONCLUSIONS After excluding exogenous glucocorticoid use, we recommend testing for Cushing's syndrome in patients with multiple and progressive features compatible with the syndrome, particularly those with a high discriminatory value, and patients with adrenal incidentaloma. We recommend initial use of one test with high diagnostic accuracy (urine cortisol, late night salivary cortisol, 1 mg overnight or 2 mg 48-h dexamethasone suppression test). We recommend that patients with an abnormal result see an endocrinologist and undergo a second test, either one of the above or, in some cases, a serum midnight cortisol or dexamethasone-CRH test. Patients with concordant abnormal results should undergo testing for the cause of Cushing's syndrome. Patients with concordant normal results should not undergo further evaluation. We recommend additional testing in patients with discordant results, normal responses suspected of cyclic hypercortisolism, or initially normal responses who accumulate additional features over time.
Subfields: Endocrinology, Diabetes and Metabolism, Surgery
View Paper: https://www.semanticscholar.org/paper/d1dcbcb32a73ec6ee7ee080cc6d3684f565051e0
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Citations in the corpus
- American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons Medical Guidelines for the Management of Adrenal Incidentalomas: executive summary of recommendations. (2009, neutral): “The 1-mg dexamethasone suppres - sion test is more sensitive than UFC in diagnosing this condition (29 [EL 4]) .”
- 2020 International Society of Hypertension Global Hypertension Practice Guidelines. (2020, neutral): “Increased late night salivary cortisol Dexamethasone suppression tests [118]”
- 2020 International Society of Hypertension global hypertension practice guidelines. (2020, background): “Increased late night salivary cortisol Dexamethasone suppression tests [118]”
- Consensus on Diagnosis and Management of Cushing’s Disease: A Guideline Update (2021, neutral): “5,27 One advantage with UFC over DST is that overall cortisol production is independent of CBG changes and dexamethasone metabolism or compliance.”
- Treatment of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline. (2015, background): “(17) 2810 Nieman et al Guidelines on Cushing’s Syndrome Treatment J Clin Endocrinol Metab, August 2015, 100(8):2807–2831”
- Diagnosis and Treatment of Polycystic Ovary Syndrome: An Endocrine Society Clinical Practice Guideline (2013, background): “Cushing’s syndrome Many of the signs and symptoms of PCOS can overlap with Cushing’s (ie, striae, obesity, dorsocervical fat (ie, buffalo hump, glucose intolerance); however, Cushing’s is more likely to be present when a large number of signs and symptoms, especially those with high discriminatory i”