Last reviewed: November 2017
Last updated: October  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • sudden cessation or rapid tapering of glucocorticoids
  • hx of weight gain and increased appetite
  • hx of depression, agitation, or sleep disorders
  • hx of easy bruising
  • fatigue, anorexia, or weight loss
  • nausea or vomiting
  • dizziness or orthostatic symptoms
  • myalgia or arthralgia
  • abdominal pain
  • cushingoid examination features

Other diagnostic factors

  • hx of difficult-to-control diabetes or hypertension
  • absence of hyperpigmentation or autoimmune stigmata
  • typical features of underlying disease
  • medroxyprogesterone acetate use
  • hx of treatment for endogenous Cushing's syndrome
  • hypotension with or without orthostasis

Risk factors

  • systemic glucocorticoid administration
  • high potency or dose of exogenous glucocorticoids
  • local glucocorticoid administration
  • glucocorticoid treatment >3 weeks
  • non-physiological scheduling of glucocorticoid dose
  • megestrol use
  • medroxyprogesterone use

Diagnostic investigations

1st investigations to order

  • serum comprehensive chemistry panel
  • serum a.m. cortisol
  • salivary a.m. cortisol
  • ACTH stimulation test
Full details

Investigations to consider

  • insulin tolerance test (ITT)
  • overnight metyrapone test
  • urine synthetic glucocorticoids
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

M. Cecilia Lansang

Associate Professor

Department of Endocrinology

Cleveland Clinic Foundation

Cleveland

OH

Disclosures

MCL is an author of one reference cited in this monograph.

Suzanne L. Quinn

Staff Endocrinologist

Orlando Veterans Administration Hospital

Associate Professor Internal Medicine

University of Central Florida

Orlando

FL

Disclosures

SLQ declares that she has no competing interests.

Peer reviewers VIEW ALL

Head

Department of Endocrinology

University Hospital of Bordeaux

Pessac

France

Disclosures

AT declares that he has no competing interests.

Clinical Lecturer

Honorary Consultant

Department of Endocrinology

Barts and The London School of Medicine and Dentistry

St Bartholomew's Hospital

London

UK

Disclosures

MD declares that she has no competing interests.

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