Do not measure serum cortisol and plasma corticotropin (ACTH) at random times during the day as first-line tests in suspected Cushing’s syndrome.

Do not measure serum cortisol and plasma corticotropin (ACTH) at random times during the day as first-line tests in suspected Cushing’s syndrome.

Type of practice

Laboratory tests

Age

Pediatric

Topic Area

Laboratory Medicine

For screening of Cushing’s syndrome it is recommended to use one of the following three tests: urinary cortisol (at least two 24-hour collections), nocturnal salivary cortisol (two samples on two different days), serum cortisol after overnight dexamethasone 1 mg suppression test (oDST). This approach is strongly supported by authoritative scientific societies and is aligned with up-to-date and Evidence-Based literature.

Sources

1. Nieman LK, Biller BM, Findling JW, et al. The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2008; 93: 1526-40. DOI: 10.1210/jc.2008-0125.
2. D’Aurizio F, Tozzoli R, Dorizzi RM, et al. La diagnostica di laboratorio delle malattie del surrene. Raccomandazioni pratiche per la sindrome di Cushing. Riv Ital Med Lab 2015; 11: 132-49. DOI: 10.1007/s13631-015-0088-0
3. Galm BP, Qiao N, Klibanski A, et al. Accuracy of laboratory tests for the diagnosis of Cushing syndrome. J Clin Endocrinol Metab 2020; 105:2081–94. DOI: 10.1210/clinem/dgaa105.
4. Braun LT, Vogel F, Zopp S, et al. Whom Should We Screen for Cushing Syndrome? The Endocrine Society Practice guideline recommendations 2008 revisited. J Clin Endocrinol Metab 2022;107: e3723-30. DOI: 10.1210/clinem/dgac379.
5. Centre de référence des maladies rares de la surrénale. Extraite du Protocole National de Diagnostic et de Soins (PNDS) Syndrome de Cushing Janvier 2023 [Internet] Available from: https://www.has-sante.fr/upload/docs/application/pdf/2023-01/synthese_mg_syndrome_de_cushing.pdf (last accessed March 2024).

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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.