endocrine and metabolic disorders
Cushing Syndrome
Key Points
Diagnosis is usually made by elevated nocturnal serum or salivary cortisol levels, or 24-hour urinary free cortisol level, and adexamethasonesuppression test in which serum cortisol does not suppress. Pituitary causes are distinguished from nonpituitary causes by adrenocorticotropic hormone (ACTH) levels. Imaging is then done to identify any causative tumor. Tumors are usually treated surgically or with radiation therapy. Metyrapone,ketoconazole,levoketoconazole, orosilodrostatmay be given to suppress adrenal cortisol secretion prior to definitive treatment or the receptor antagonistmifepristonemay be given. Pasireotideorcabergolineto suppress ACTH secretion may be given to patients with recurrent pituitary or disseminated ectopic ACTH-producing tumors. 