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
- adrenocorticotropic hormone (ACTH) stimulation test
Investigations to consider
- insulin tolerance test (ITT)
- overnight metyrapone test
- urine synthetic glucocorticoids
Treatment algorithm
Contributors
Authors VIEW ALL
Associate Professor
Department of Endocrinology
Cleveland Clinic Foundation
Cleveland
OH
Disclosures
MCL is an author of one reference cited in this monograph.
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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