Diagnostic approach to Cushing disease.

Bradley A. Gross, Stefan A. Mindea, Anthony J. Pick, James P. Chandler, H. Hunt Batjer

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

In Cushing disease, a pituitary corticotroph neoplasm causes secondary adrenal hypercortisolism. This condition has known morbidity and mortality, underscoring the need for an efficient and accurate diagnostic approach. An 11 p.m. salivary cortisol level is a modern, simple initial screening tool for the diagnosis of Cushing syndrome. Confirmation with a 24-hour urinary free cortisol test and/or a low-dose dexamethasone suppression test may subsequently be performed. Patients with repeatedly equivocal results should be reevaluated after several months or undergo a corticotropin-releasing hormone (CRH) stimulation test following low-dose dexamethasone suppression to help rule out pseudo-Cushing states. The presence of low morning serum adrenocorticotropic hormone (ACTH) levels then distinguishes primary adrenal hypercortisolism from Cushing disease and the ectopic ACTH syndrome. Patients with moderate ACTH levels can undergo CRH stimulation testing to clarify the underlying disease because those with an ACTH-independent disorder have blunted subsequent ACTH levels. Once ACTH-dependent hypercortisolemia is detected, magnetic resonance (MR) imaging of the pituitary gland can be performed to detect a pituitary neoplasm. Normal or equivocal MR imaging results revealing small pituitary lesions should be followed up with inferior petrosal sinus sampling, a highly specific measure for the diagnosis of Cushing disease in experienced hands. If necessary, body imaging may be used in turn to detect sources of ectopic ACTH.

Original languageEnglish (US)
JournalNeurosurgical Focus
Volume23
Issue number3
StatePublished - 2007

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Pituitary ACTH Hypersecretion
Adrenocorticotropic Hormone
Cushing Syndrome
Corticotropin-Releasing Hormone
Pituitary Neoplasms
Dexamethasone
Hydrocortisone
Paraneoplastic Endocrine Syndromes
Petrosal Sinus Sampling
Ectopic Hormones
Magnetic Resonance Imaging
Corticotrophs
Pituitary Gland
Morbidity
Mortality
Serum

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Gross, B. A., Mindea, S. A., Pick, A. J., Chandler, J. P., & Batjer, H. H. (2007). Diagnostic approach to Cushing disease. Neurosurgical Focus, 23(3).

Diagnostic approach to Cushing disease. / Gross, Bradley A.; Mindea, Stefan A.; Pick, Anthony J.; Chandler, James P.; Batjer, H. Hunt.

In: Neurosurgical Focus, Vol. 23, No. 3, 2007.

Research output: Contribution to journalArticle

Gross, BA, Mindea, SA, Pick, AJ, Chandler, JP & Batjer, HH 2007, 'Diagnostic approach to Cushing disease.', Neurosurgical Focus, vol. 23, no. 3.
Gross BA, Mindea SA, Pick AJ, Chandler JP, Batjer HH. Diagnostic approach to Cushing disease. Neurosurgical Focus. 2007;23(3).
Gross, Bradley A. ; Mindea, Stefan A. ; Pick, Anthony J. ; Chandler, James P. ; Batjer, H. Hunt. / Diagnostic approach to Cushing disease. In: Neurosurgical Focus. 2007 ; Vol. 23, No. 3.
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