How Is Cushings Syndrome Diagnosed?
In addition to a complete medical history and physical examination, diagnostic procedures for Cushing’s syndrome may include: • x-ray – a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. • 24-hour urinary test (urine is collected over a 24-hour period to measure for corticosteroid hormones) • computed tomography scan (Also called a CT or CAT scan.) – a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays. • magnetic resonance imaging (MRI) – a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
Most people who appear to have some of the classic physical features of Cushing’s Syndrome (cushingoid appearance) do not actually have the disease. After iatrogenic Cushing’s is excluded, other causes of this appearance cn be polycystic ovary syndrome (androgen excess from the ovaries), ovarian tumors, congenital adrenal hyperplasia, ordinary obesity, excessive alcohol consumption, or just a family tendency to have a round face and abdomen with high blood pressure and high blood sugar. Because Cushing’s Syndrome is a rare but serious disorder, it is very important to carefully exclude (rule out) other disorders and then separate the different types, leading eventually to a specific cause that can be treated. This process of testing and excluding usually takes days to weeks and requires a lot of patience and cooperation by the person being tested. After the initial history, physical exam and routine blood tests, the first step is to prove cortisol excess with specific blood and 24 hour
Diagnosis is based on a review of the patient’s medical history, physical examination and laboratory tests. Often x-ray exams of the adrenal or pituitary glands are useful for locating tumors. These tests help to determine if excess levels of cortisol are present and why. 24-Hour Urinary Free Cortisol Level This is the most specific diagnostic test. The patient’s urine is collected over a 24-hour period and tested for the amount of cortisol. Levels higher than 50-100 micrograms a day for an adult suggest Cushing’s syndrome. The normal upper limit varies in different laboratories, depending on which measurement technique is used. Once Cushing’s syndrome has been diagnosed, other tests are used to find the exact location of the abnormality that leads to excess cortisol production. The choice of test depends, in part, on the preference of the endocrinologist or the center where the test is performed. Dexamethasone Suppression Test This test helps to distinguish patients with excess produc
Your doctor will use your medical history, a physical examination, and laboratory tests to diagnose Cushing’s syndrome. During the physical examination, he or she will look for signs of the condition. The medical history includes questions about any symptoms you have, what medicines you are taking, and, if you are a woman, whether your menstrual periods are regular. If your doctor thinks you may have Cushing’s syndrome, you will have laboratory tests to check the level of cortisol in your blood and urine. Further testing may be needed to find the cause of high cortisol levels. How is it treated? If corticosteroid medicine is causing Cushing’s syndrome, your doctor will recommend lowering the dose or gradually stopping the medicine. It may take a while for the signs and symptoms of Cushing’s syndrome to go away. If a tumor is causing the condition, it must be removed through surgery. Medicines may be used to lower cortisol levels when tumors cannot be removed. Living with Cushing’s synd
