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
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
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 Médicas 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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