help button home button Endocrine Society JCEM
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS

Journal of Clinical Endocrinology & Metabolism , doi:10.1210/jc.2006-0997
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit a related Letter to the Editor
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow Request Copyright Permission
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Findling, J. W.
Right arrow Articles by Raff, H.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Findling, J. W.
Right arrow Articles by Raff, H.
Related Collections
Right arrow Adrenal and Hypertension
Right arrow Neuroendocrinology and Pituitary
Right arrow Endocrine Oncology
The Journal of Clinical Endocrinology & Metabolism Vol. 91, No. 10 3746-3753
Copyright © 2006 by The Endocrine Society


CLINICAL REVIEW

Cushing’s Syndrome: Important Issues in Diagnosis and Management

James W. Findling and Hershel Raff

Endocrine-Diabetes Center (J.W.F.) and Endocrine Research Laboratory (H.R.), St. Luke’s Medical Center, Milwaukee, Wisconsin 53215; and Department of Medicine (J.W.F., H.R.), Medical College of Wisconsin, Milwaukee, Wisconsin 53226

Address all correspondence and requests for reprints to: Hershel Raff, Ph.D., Endocrinology, St. Luke’s Physician’s Office Building, 2801 West KK River Parkway, Suite 245, Milwaukee, Wisconsin 53215. E-mail: hraff{at}mcw.edu.

Context: The diagnosis, differential diagnosis, and treatment of Cushing’s syndrome are challenging problems in clinical endocrinology. We focus on critical questions addressing screening for Cushing’s syndrome, differentiation of Cushing’s subtypes, and treatment options.

Evidence Acquisition: Ovid’s MEDLINE (1996 through April 2006) was used to search the general literature. We also relied on previously published reviews and a recent monograph and cite a mix of primary articles and recent reviews.

Evidence Synthesis: Although this article represents our opinion, it draws heavily on a recent consensus statement from experts in the field and a recent monograph on Cushing’s syndrome.

Conclusions: We concluded that: 1) measurement of late-night or bedtime salivary cortisol is a useful approach to screen for Cushing’s syndrome; 2) measurement of suppressed plasma ACTH by immunometric assay is useful to differentiate ACTH-dependent and -independent Cushing’s syndrome; 3) inferior petrosal sinus sampling for ACTH should be performed in patients with ACTH-dependent hypercortisolism in whom a pituitary magnetic resonance imaging is normal or equivocal (in the absence of a pituitary ACTH gradient, prolactin levels should be measured to confirm the integrity of venous sampling); 4) computed tomography of the chest and abdomen and somatostatin receptor scintigraphy should be performed in patients with the occult ectopic ACTH syndrome; and 5) patients with Cushing’s disease should be referred to a neurosurgeon with extensive experience operating on corticotroph microadenomas. Bilateral laparoscopic adrenalectomy should be considered in patients with Cushing’s disease who fail therapies directed at the pituitary.




This article has been cited by other articles:


Home page
Eur J EndocrinolHome page
A. Takeshita, N. Inoshita, M. Taguchi, C. Okuda, N. Fukuhara, K. Oyama, K. Ohashi, T. Sano, Y. Takeuchi, and S. Yamada
High incidence of low O6-methylguanine DNA methyltransferase expression in invasive macroadenomas of Cushing's disease
Eur. J. Endocrinol., October 1, 2009; 161(4): 553 - 559.
[Abstract] [Full Text] [PDF]


Home page
J. Clin. Endocrinol. Metab.Home page
H. Raff
Utility of Salivary Cortisol Measurements in Cushing's Syndrome and Adrenal Insufficiency
J. Clin. Endocrinol. Metab., October 1, 2009; 94(10): 3647 - 3655.
[Abstract] [Full Text] [PDF]


Home page
J. Clin. Endocrinol. Metab.Home page
M. Boscaro and G. Arnaldi
Approach to the Patient with Possible Cushing's Syndrome
J. Clin. Endocrinol. Metab., September 1, 2009; 94(9): 3121 - 3131.
[Abstract] [Full Text] [PDF]


Home page
Ann Clin BiochemHome page
P. Wood
Salivary steroid assays - research or routine?
Ann Clin Biochem, May 1, 2009; 46(3): 183 - 196.
[Abstract] [Full Text] [PDF]


Home page
Ann Clin BiochemHome page
A. C Heijboer, F. Martens, and M. A Blankenstein
Measuring salivary cortisol with the Architect i2000 random access analyser
Ann Clin Biochem, May 1, 2009; 46(3): 261 - 262.
[Full Text] [PDF]


Home page
Eur J EndocrinolHome page
B. Masserini, V. Morelli, S. Bergamaschi, F. Ermetici, C. Eller-Vainicher, A. M. Barbieri, M. A. Maffini, A. Scillitani, B. Ambrosi, P. Beck-Peccoz, et al.
The limited role of midnight salivary cortisol levels in the diagnosis of subclinical hypercortisolism in patients with adrenal incidentaloma
Eur. J. Endocrinol., January 1, 2009; 160(1): 87 - 92.
[Abstract] [Full Text] [PDF]


Home page
J. Clin. Endocrinol. Metab.Home page
S. Jehle, J. E. Walsh, P. U. Freda, and K. D. Post
Selective Use of Bilateral Inferior Petrosal Sinus Sampling in Patients with Adrenocorticotropin-Dependent Cushing's Syndrome Prior to Transsphenoidal Surgery
J. Clin. Endocrinol. Metab., December 1, 2008; 93(12): 4624 - 4632.
[Abstract] [Full Text] [PDF]


Home page
HypertensionHome page
E. Singer, S. Strohm, U. Gobel, M. Bieringer, D. Schmidt, W. Schneider, R. Kettritz, and F. C. Luft
Cushing's Disease, Hypertension, and Other Sequels
Hypertension, December 1, 2008; 52(6): 1001 - 1005.
[Full Text] [PDF]


Home page
Eur J EndocrinolHome page
P. Burman, A. Lethagen, K. Ivancev, L. Johansson, and A. Sundin
Dual bronchial carcinoids and Cushing's syndrome with a paradoxical response to dexamethasone and a false positive outcome of inferior petrosal sinus sampling
Eur. J. Endocrinol., October 1, 2008; 159(4): 483 - 488.
[Abstract] [Full Text] [PDF]


Home page
J. Clin. Endocrinol. Metab.Home page
J. Moreno-Fernandez, C. Gutierrez-Alcantara, M. A. Galvez Moreno, L. Jimenez-Reina, J. P. Castano, and P. Benito-Lopez
Corticotrophin-Dependent Cushing Syndrome Due to Sacrococcygeal Teratoma Detected by [18F]Fluorodeoxyglucose Positron Emission Tomography
J. Clin. Endocrinol. Metab., September 1, 2008; 93(9): 3282 - 3283.
[Full Text] [PDF]


Home page
Ann Clin BiochemHome page
L. Wood, D. H Ducroq, H. L Fraser, S. Gillingwater, C. Evans, A. J Pickett, D. W Rees, R. John, and A. Turkes
Measurement of urinary free cortisol by tandem mass spectrometry and comparison with results obtained by gas chromatography-mass spectrometry and two commercial immunoassays
Ann Clin Biochem, July 1, 2008; 45(4): 380 - 388.
[Abstract] [Full Text] [PDF]


Home page
J. Clin. Endocrinol. Metab.Home page
B. M. K. Biller, A. B. Grossman, P. M. Stewart, S. Melmed, X. Bertagna, J. Bertherat, M. Buchfelder, A. Colao, A. R. Hermus, L. J. Hofland, et al.
Treatment of Adrenocorticotropin-Dependent Cushing's Syndrome: A Consensus Statement
J. Clin. Endocrinol. Metab., July 1, 2008; 93(7): 2454 - 2462.
[Abstract] [Full Text] [PDF]


Home page
J. Neuropsychiatry Clin. Neurosi.Home page
P. C. Myhill, B. A. Sillars, S. Starkstein, T. Annus, and B. B. Yeap
Reduction in Salivary Cortisol Concentration Correlates with Resolution of Psychosis in Cushing's Syndrome
J Neuropsychiatry Clin Neurosci, February 1, 2008; 20(1): 113 - 115.
[Full Text] [PDF]


Home page
Eur J EndocrinolHome page
S. Kidambi, H. Raff, and J. W Findling
Limitations of nocturnal salivary cortisol and urine free cortisol in the diagnosis of mild Cushing's syndrome
Eur. J. Endocrinol., December 1, 2007; 157(6): 725 - 731.
[Abstract] [Full Text] [PDF]


Home page
J. Clin. Endocrinol. Metab.Home page
S. K. Baid, N. Sinaii, M. Wade, D. Rubino, and L. K. Nieman
Radioimmunoassay and Tandem Mass Spectrometry Measurement of Bedtime Salivary Cortisol Levels: A Comparison of Assays to Establish Hypercortisolism
J. Clin. Endocrinol. Metab., August 1, 2007; 92(8): 3102 - 3107.
[Abstract] [Full Text] [PDF]


Home page
Eur Heart JHome page
Authors/Task Force Members:, G. Mancia, G. De Backer, A. Dominiczak, R. Cifkova, R. Fagard, G. Germano, G. Grassi, A. M. Heagerty, S. E. Kjeldsen, et al.
2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)
Eur. Heart J., June 11, 2007; (2007) ehm236v1.
[Full Text] [PDF]


Home page
J. Clin. Endocrinol. Metab.Home page
S. Tsagarakis, D. Vassiliadi, I. S. Kaskarelis, J. Komninos, E. Souvatzoglou, and N. Thalassinos
The Application of the Combined Corticotropin-Releasing Hormone plus Desmopressin Stimulation during Petrosal Sinus Sampling Is Both Sensitive and Specific in Differentiating Patients with Cushing's Disease from Patients with the Occult Ectopic Adrenocorticotropin Syndrome
J. Clin. Endocrinol. Metab., June 1, 2007; 92(6): 2080 - 2086.
[Abstract] [Full Text] [PDF]




HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Endocrinology Endocrine Reviews J. Clin. End. & Metab.
Molecular Endocrinology Recent Prog. Horm. Res. All Endocrine Journals
Copyright © 2006 by The Endocrine Society