Newswise — The Endocrine Society has released new clinical practice guidelines for the diagnosis of Cushing's syndrome. The guidelines appear in the May issue of the Journal of Clinical Endocrinology & Metabolism (JCEM), a publication of The Endocrine Society.

Cushing's syndrome is an endocrine disorder caused by an abnormally high circulating level of cortisol, a corticosteroid hormone produced in the adrenal gland. The vast majority of cases of Cushing's syndrome are caused by steroid medications, such as those used to treat asthma or rheumatoid arthritis. This type of Cushing's, referred to as exogenous (since the causes come from outside the body), is temporary and goes away after the patient ceases taking the medication. Endogenous Cushing's syndrome is unusual. It usually comes on slowly and can be difficult to diagnose. It is caused either by a problem with the adrenal glands, the pituitary (a gland located at the base of the brain), or a tumor in another location. In the adrenal glands, the problem is caused by a tumor (usually non-cancerous) that produces too much cortisol. When the problem originates outside of the adrenal glands, it is caused by a tumor that produces too much ACTH (spell out ACTH)—the hormone that tells the adrenal glands to make cortisol.

Signs and symptoms of Cushing's syndrome include weight gain, high blood sugar, high blood pressure, thin bones, easily bruised skin, depression, and reduced sex drive. Although Cushing's syndrome is clinically unmistakable when full-blown, the spectrum of clinical presentations [can we say "symptoms" ? presentations is rather jargon] is broad, and the diagnosis can be challenging in mild cases.

"Patients with Cushing's syndrome often have a number of features that are caused by cortisol excess but which are also common in the general population, such as obesity, depression, diabetes, hypertension, or menstrual irregularity," said Lynnette Nieman, MD, of the National Institute of Child Health and Human Development and chair of the task force that developed these guidelines. "If Cushing's syndrome is not considered, the diagnosis is all too often delayed, and this is unfortunate as early recognition and treatment could reduce the risk of morbidity."

After excluding steroid medications, the guidelines suggest testing of Cushing's syndrome in patients with multiple and progressive features compatible with the syndrome. They also provide recommendations for which tests to use and how to proceed if the tests results are abnormal.

The guidelines were developed by a task force chaired by Dr. Nieman. Other members of the task force included Beverly Biller of Harvard Medical School in Boston, Massachusetts; James Findling of Medical College of Wisconsin in Milwaukee, Wisconsin; John Newell-Price of the University of Sheffield in Sheffield, United Kingdom; Martin Savage of Queen Mary University in London, United Kingdom; Paul Stewart of the University of Birmingham in Birmingham, United Kingdom; and Victor Montori of Mayo Clinic in Rochester, Minnesota.

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Journal of Clinical Endocrinology & Metabolism (May-2008)