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The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline.
J Clin Endocrinol Metab. 2008 May; 93(5):1526-40.JC

Abstract

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.

Authors+Show Affiliations

Program on Reproductive and Adult Endocrinology, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA. govt-prof@endo.society.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Practice Guideline

Language

eng

PubMed ID

18334580

Citation

Nieman, Lynnette K., et al. "The Diagnosis of Cushing's Syndrome: an Endocrine Society Clinical Practice Guideline." The Journal of Clinical Endocrinology and Metabolism, vol. 93, no. 5, 2008, pp. 1526-40.
Nieman LK, Biller BM, Findling JW, et al. The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2008;93(5):1526-40.
Nieman, L. K., Biller, B. M., Findling, J. W., Newell-Price, J., Savage, M. O., Stewart, P. M., & Montori, V. M. (2008). The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology and Metabolism, 93(5), 1526-40. https://doi.org/10.1210/jc.2008-0125
Nieman LK, et al. The Diagnosis of Cushing's Syndrome: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2008;93(5):1526-40. PubMed PMID: 18334580.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline. AU - Nieman,Lynnette K, AU - Biller,Beverly M K, AU - Findling,James W, AU - Newell-Price,John, AU - Savage,Martin O, AU - Stewart,Paul M, AU - Montori,Victor M, Y1 - 2008/03/11/ PY - 2008/3/13/pubmed PY - 2008/6/18/medline PY - 2008/3/13/entrez SP - 1526 EP - 40 JF - The Journal of clinical endocrinology and metabolism JO - J Clin Endocrinol Metab VL - 93 IS - 5 N2 - 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. SN - 0021-972X UR - https://www.unboundmedicine.com/medline/citation/18334580/The_diagnosis_of_Cushing's_syndrome:_an_Endocrine_Society_Clinical_Practice_Guideline_ L2 - https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2008-0125 DB - PRIME DP - Unbound Medicine ER -