Do not measure random serum cortisol and plasma corticotrophin (ACTH) and urinary 17-ketosteroids and do not perform insulin tolerance tests, Loperamide test and Dexamethasone test (8 mg), when Cushing syndrome is suspected.
For screening Cushing syndrome one of the following three tests is recommended: Urinary Free Cortisol (at least two 24-hour collections), night salivary cortisol (two samples collected in two different days), serum cortisol after overnight dexamethasone suppression test, 1 mg (oDST) or after dexamethasone suppression test, 2 mg/day for 48 hours.
1. Nieman LK, Biller BM, Findling JW, et al (2008) The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 93:1526-40.
2. Guignat L, Bertherat J (2010) The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline: commentary from a European perspective. Eur J Endocrinol 163:9-13.
3. D’Aurizio F, Tozzoli R, Dorizzi RM, et al (2015) La diagnostica di laboratorio delle malattie del surrene. Raccomandazioni pratiche per la sindrome di Cushing. Riv Ital Med Lab 11: 132-149.
4. Nieman LK, Biller BM, Findling JW, et al (2015) Treatment of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 100: 2807-2831.
Attention. Please note that these items are provided only for information and are not intended as a substitute for consultation with a clinician. Patients with any specific questions about the items on this list or their individual situation should consult their clinician.