Info

🌱 來自: Cushing’s Syndrome

Diagnosis Cushing’s Syndrome

• Typically performed in outPt setting
• Very difficult as inPt b/c hypercortisolism from acute illness and hosp. (NEJM 2017;376:1451)

• suspect Cushing’s Syndrome Clinically
• 3 options for screening for hypercortisolism
• Results:
  • negative and low clinical suspicion of hypercortisolism
  • positive and high clinical suspicion hypercortisolism
    • ✅ 24-hr UFC again
  • positive but pt w/ acute illness, alcohol, depression
    • re ✅ after resolution of illness or
    • ✅ combined
      • 48-hr LD-dexamethasone suppression test
      • CRH stimulations test
• if positive:

Differentiate level of defect by checking serum adrenocorticotrophic hormone

✅ ACTH level

adrenocorticotrophic hormone dependent

• 48-hr or Overnight high-dose DST (or CRH test)
  • will not suppress or negative stimulations
    • chest/abdominal CT
    • somatostatin scan
      • negative → BIPSS
  • will suppress or positive stimulations
    • pituitary MRI
      • positive → Cushing’s disease
      • negative → BIPSS
  • BIPSS
    • positive → Cushing’s disease
    • negative → Ectopic ACTH

adrenocorticotrophic hormone independent

• adrenal computed tomogram or magnetic resonance imaging
• Adrenal tumor

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• O/N HD DST = 8 mg at 11 p.m.; ✓ 9 a.m. serum cortisol (suppression if <50% from day prior)