Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- sudden cessation or rapid tapering of glucocorticoids
- acute circulatory collapse with hypotension and tachycardia
Other diagnostic factors
- lassitude and generalised constitutional symptoms
- history of weight gain and increased appetite
- history of depression, agitation, or sleep disorders
- history of easy bruising
- cushingoid examination features
- history of difficult-to-control diabetes or hypertension
- absence of hyperpigmentation or autoimmune stigmata
- typical features of underlying disease
- medroxyprogesterone acetate use
- history of treatment for endogenous Cushing's syndrome
Risk factors
- systemic glucocorticoid administration
- high potency or dose of exogenous glucocorticoids
- prolonged glucocorticoid treatment (e.g., >3 weeks)
- local glucocorticoid administration
- 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
- FBC
- thyroid function tests
Investigations to consider
- insulin tolerance test (ITT)
- overnight metyrapone test
- urine synthetic glucocorticoids
Treatment algorithm
Contributors
Authors

Professor of Medicine
Department of Endocrinology
Cleveland Clinic Foundation
Cleveland
OH
Disclosures
MCL is an author of one reference cited in this topic.

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
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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