Last reviewed: July 2020
Last updated: August  2020

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 generalized constitutional symptoms
  • history of weight gain and increased appetite
  • history of depression, agitation, or sleep disorders
  • history of easy bruising
  • cushingoid exam 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 syndrome

Risk factors

  • systemic glucocorticoid administration
  • high potency or dose of exogenous glucocorticoids
  • prolonged glucocorticoid treatment (e.g., >3 weeks)
  • local glucocorticoid administration
  • nonphysiologic 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
  • CBC
  • thyroid function tests
More 1st investigations to order

Investigations to consider

  • insulin tolerance test (ITT)
  • overnight metyrapone test
  • urine synthetic glucocorticoids
More investigations to consider

Treatment algorithm

Contributors

M. Cecilia Lansang

Professor of Medicine

Department of Endocrinology

Cleveland Clinic Foundation

Cleveland

OH

Disclosures

MCL is an author of one reference cited in this topic.

Suzanne L. Quinn

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 reviewersVIEW 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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