Last reviewed: July 2018
Last updated: January  2018



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 gender
  • 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


Authors VIEW ALL

Professor of Medicine (Endocrinology) and Neurological Surgery


Pituitary Center

Oregon Health & Science University




MF is an author of several references cited in this monograph. She is a scientific consultant and principal investigator (with a grant to the university) for Novartis and Strongbridge. She is an unpaid medical advisor for the Cushing's Support and Research Foundation; she is also chair of the Endocrine Society Guidelines Committee, chair of the Pituitary Society Physician Education Committee, and member of the Board of Directors of the Pituitary Society.

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




PMS declares that he has no competing interests.


Department of Endocrinology

University Hospital of Bordeaux




AT declares that he has no competing interests.


Endocrine Research Department

Instituto de Investigaciones M├ędicas A. Lanari

University of Buenos Aires and IDIM-CONICET

Buenos Aires



LC declares that she has no competing interests.

Professor of Medicine


Division of Endocrinology, Diabetes & Metabolism

University of Texas Medical School




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




MAH declares that he has no competing interests.

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