Last reviewed: October 2018
Last updated: October  2018

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • facial plethora
  • supraclavicular fullness
  • violaceous striae
  • absence of pregnancy
  • menstrual irregularities
  • absence of malnutrition
  • absence of alcoholism
  • absence of physiological stress
  • linear growth deceleration in children

Other diagnostic factors

  • female sex
  • hypertension
  • glucose intolerance or diabetes mellitus
  • premature osteoporosis or unexplained fractures
  • weight gain and central obesity
  • acne
  • psychiatric symptoms
  • decreased libido
  • easy bruisability
  • weakness
  • facial rounding
  • dorsocervical fat pads
  • unexplained nephrolithiasis
  • hirsutism

Risk factors

  • exogenous corticosteroid use
  • pituitary adenoma
  • adrenal adenoma
  • adrenal carcinoma
  • neuroendocrine tumours
  • thoracic or bronchogenic carcinoma

Diagnostic investigations

1st investigations to order

  • urine pregnancy test
  • serum glucose
  • late-night salivary cortisol
  • 1 mg overnight dexamethasone suppression test
  • 24-hour urinary free cortisol
  • 48-hour 2 mg (low-dose) dexamethasone suppression test
Full details

Investigations to consider

  • plasma dehydroepiandrosterone sulphate (DHEAS) level
  • morning plasma adrenocorticotropic hormone (ACTH)
  • high-dose dexamethasone suppression test
  • pituitary MRI
  • adrenal CT
  • inferior petrosal sinus sampling
  • CT of chest, abdomen, and pelvis
  • MRI chest
  • PET scan
  • octreotide scanning
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Professor of Medicine (Endocrinology) and Neurological Surgery

Director

Pituitary Center

Oregon Health & Science University

Portland

OR

Disclosures

MF is the Pituitary Society's President Elect, and sits on it's Board of Directors. She holds a research grant to the University for Clinical Studies as Principal Investigator for Novartis and Strongbridge, and is Scientific Consultant for Novartis and Strongbridge. MF is an author of several references cited in this monograph.

Dr Maria Fleseriu would like to gratefully acknowledge Dr Ty Carroll and Dr James Finding, previous contributors to this monograph. TC is an author of a number of references cited in this monograph. He is an investigator in clinical trials sponsored by Corcept. JF is an author of a number of references cited in this monograph. He is a consultant for, and investigator in, clinical trials sponsored by Corcept and Novartis.

Peer reviewers VIEW ALL

Professor of Medicine

Director of Research

College of Medical and Dental Sciences

University of Birmingham

Honorary Consultant Physician

Queen Elizabeth Hospital

Birmingham

UK

Disclosures

PMS declares that he has no competing interests.

Head

Department of Endocrinology

University Hospital of Bordeaux

Pessac

France

Disclosures

AT declares that he has no competing interests.

Chief

Endocrine Research Department

Instituto de Investigaciones M├ędicas A. Lanari

University of Buenos Aires and IDIM-CONICET

Buenos Aires

Argentina

Disclosures

LC declares that she has no competing interests.

Professor of Medicine

Director

Division of Endocrinology, Diabetes & Metabolism

University of Texas Medical School

Houston

TX

Disclosures

PRO declares that he has no competing interests.

Assistant Professor

Department of Endocrine Neoplasia and Hormonal Disorders

Division of Internal Medicine

University of Texas MD Anderson Cancer Center

Houston

TX

Disclosures

MAH declares that he has no competing interests.

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