The diagnosis of Cushing's syndrome: An endocrine society clinical practice guideline

Lynnette K. Nieman, Beverly M K Biller, James W. Findling, John Newell-Price, Martin O. Savage, Paul M. Stewart, Victor Manuel Montori, Heather Edwards

Research output: Contribution to journalArticle

1141 Citations (Scopus)

Abstract

Objective: The objective of the study was to develop clinical practice guidelines for the diagnosis of Cushing's syndrome. Participants: The Task Force included a chair, selected by the Clinical Guidelines Subcommittee (CGS) of The Endocrine Society, five additional experts, a methodologist, and a medical writer. The Task Force received no corporate funding or remuneration. Consensus Process: Consensus was guided by systematic reviews of evidence and discussions. The guidelines were reviewed and approved sequentially by The Endocrine Society's CGS and Clinical Affairs Core Committee, members responding to a web posting, and The Endocrine Society Council. At each stage the Task Force incorporated needed changes in response to written comments. Conclusions: After excluding exogenous glucocorticoid use, we recommend testing for Cushing's syndrome in patients with multiple and progressive features compatible with the syndrome, particularly those with a high discriminatory value, and patients with adrenal incidentaloma. We recommend initial use of one test with high diagnostic accuracy (urine cortisol, late night salivary cortisol, 1 mg overnight or 2 mg 48-h dexamethasone suppression test). We recommend that patients with an abnormal result see an endocrinologist and undergo a second test, either one of the above or, in some cases, a serum midnight cortisol or dexamethasone-CRH test. Patients with concordant abnormal results should undergo testing for the cause of Cushing's syndrome. Patients with concordant normal results should not undergo further evaluation. We recommend additional testing in patients with discordant results, normal responses suspected of cyclic hypercortisolism, or initially normal responses who accumulate additional features over time.

Original languageEnglish (US)
Pages (from-to)1526-1540
Number of pages15
JournalJournal of Clinical Endocrinology and Metabolism
Volume93
Issue number5
DOIs
StatePublished - May 2008

Fingerprint

Cushing Syndrome
Practice Guidelines
Hydrocortisone
Dexamethasone
Testing
Advisory Committees
Guidelines
Glucocorticoids
Committee Membership
Remuneration
Urine
Serum

ASJC Scopus subject areas

  • Biochemistry
  • Endocrinology, Diabetes and Metabolism

Cite this

Nieman, L. K., Biller, B. M. K., Findling, J. W., Newell-Price, J., Savage, M. O., Stewart, P. M., ... Edwards, H. (2008). The diagnosis of Cushing's syndrome: An endocrine society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism, 93(5), 1526-1540. https://doi.org/10.1210/jc.2008-0125

The diagnosis of Cushing's syndrome : An endocrine society clinical practice guideline. / Nieman, Lynnette K.; Biller, Beverly M K; Findling, James W.; Newell-Price, John; Savage, Martin O.; Stewart, Paul M.; Montori, Victor Manuel; Edwards, Heather.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 93, No. 5, 05.2008, p. 1526-1540.

Research output: Contribution to journalArticle

Nieman, LK, Biller, BMK, Findling, JW, Newell-Price, J, Savage, MO, Stewart, PM, Montori, VM & Edwards, H 2008, 'The diagnosis of Cushing's syndrome: An endocrine society clinical practice guideline', Journal of Clinical Endocrinology and Metabolism, vol. 93, no. 5, pp. 1526-1540. https://doi.org/10.1210/jc.2008-0125
Nieman, Lynnette K. ; Biller, Beverly M K ; Findling, James W. ; Newell-Price, John ; Savage, Martin O. ; Stewart, Paul M. ; Montori, Victor Manuel ; Edwards, Heather. / The diagnosis of Cushing's syndrome : An endocrine society clinical practice guideline. In: Journal of Clinical Endocrinology and Metabolism. 2008 ; Vol. 93, No. 5. pp. 1526-1540.
@article{4fef9b173e2e4b63b555c384ac3513c1,
title = "The diagnosis of Cushing's syndrome: An endocrine society clinical practice guideline",
abstract = "Objective: The objective of the study was to develop clinical practice guidelines for the diagnosis of Cushing's syndrome. Participants: The Task Force included a chair, selected by the Clinical Guidelines Subcommittee (CGS) of The Endocrine Society, five additional experts, a methodologist, and a medical writer. The Task Force received no corporate funding or remuneration. Consensus Process: Consensus was guided by systematic reviews of evidence and discussions. The guidelines were reviewed and approved sequentially by The Endocrine Society's CGS and Clinical Affairs Core Committee, members responding to a web posting, and The Endocrine Society Council. At each stage the Task Force incorporated needed changes in response to written comments. Conclusions: After excluding exogenous glucocorticoid use, we recommend testing for Cushing's syndrome in patients with multiple and progressive features compatible with the syndrome, particularly those with a high discriminatory value, and patients with adrenal incidentaloma. We recommend initial use of one test with high diagnostic accuracy (urine cortisol, late night salivary cortisol, 1 mg overnight or 2 mg 48-h dexamethasone suppression test). We recommend that patients with an abnormal result see an endocrinologist and undergo a second test, either one of the above or, in some cases, a serum midnight cortisol or dexamethasone-CRH test. Patients with concordant abnormal results should undergo testing for the cause of Cushing's syndrome. Patients with concordant normal results should not undergo further evaluation. We recommend additional testing in patients with discordant results, normal responses suspected of cyclic hypercortisolism, or initially normal responses who accumulate additional features over time.",
author = "Nieman, {Lynnette K.} and Biller, {Beverly M K} and Findling, {James W.} and John Newell-Price and Savage, {Martin O.} and Stewart, {Paul M.} and Montori, {Victor Manuel} and Heather Edwards",
year = "2008",
month = "5",
doi = "10.1210/jc.2008-0125",
language = "English (US)",
volume = "93",
pages = "1526--1540",
journal = "Journal of Clinical Endocrinology and Metabolism",
issn = "0021-972X",
publisher = "The Endocrine Society",
number = "5",

}

TY - JOUR

T1 - The diagnosis of Cushing's syndrome

T2 - An endocrine society clinical practice guideline

AU - Nieman, Lynnette K.

AU - Biller, Beverly M K

AU - Findling, James W.

AU - Newell-Price, John

AU - Savage, Martin O.

AU - Stewart, Paul M.

AU - Montori, Victor Manuel

AU - Edwards, Heather

PY - 2008/5

Y1 - 2008/5

N2 - Objective: The objective of the study was to develop clinical practice guidelines for the diagnosis of Cushing's syndrome. Participants: The Task Force included a chair, selected by the Clinical Guidelines Subcommittee (CGS) of The Endocrine Society, five additional experts, a methodologist, and a medical writer. The Task Force received no corporate funding or remuneration. Consensus Process: Consensus was guided by systematic reviews of evidence and discussions. The guidelines were reviewed and approved sequentially by The Endocrine Society's CGS and Clinical Affairs Core Committee, members responding to a web posting, and The Endocrine Society Council. At each stage the Task Force incorporated needed changes in response to written comments. Conclusions: After excluding exogenous glucocorticoid use, we recommend testing for Cushing's syndrome in patients with multiple and progressive features compatible with the syndrome, particularly those with a high discriminatory value, and patients with adrenal incidentaloma. We recommend initial use of one test with high diagnostic accuracy (urine cortisol, late night salivary cortisol, 1 mg overnight or 2 mg 48-h dexamethasone suppression test). We recommend that patients with an abnormal result see an endocrinologist and undergo a second test, either one of the above or, in some cases, a serum midnight cortisol or dexamethasone-CRH test. Patients with concordant abnormal results should undergo testing for the cause of Cushing's syndrome. Patients with concordant normal results should not undergo further evaluation. We recommend additional testing in patients with discordant results, normal responses suspected of cyclic hypercortisolism, or initially normal responses who accumulate additional features over time.

AB - Objective: The objective of the study was to develop clinical practice guidelines for the diagnosis of Cushing's syndrome. Participants: The Task Force included a chair, selected by the Clinical Guidelines Subcommittee (CGS) of The Endocrine Society, five additional experts, a methodologist, and a medical writer. The Task Force received no corporate funding or remuneration. Consensus Process: Consensus was guided by systematic reviews of evidence and discussions. The guidelines were reviewed and approved sequentially by The Endocrine Society's CGS and Clinical Affairs Core Committee, members responding to a web posting, and The Endocrine Society Council. At each stage the Task Force incorporated needed changes in response to written comments. Conclusions: After excluding exogenous glucocorticoid use, we recommend testing for Cushing's syndrome in patients with multiple and progressive features compatible with the syndrome, particularly those with a high discriminatory value, and patients with adrenal incidentaloma. We recommend initial use of one test with high diagnostic accuracy (urine cortisol, late night salivary cortisol, 1 mg overnight or 2 mg 48-h dexamethasone suppression test). We recommend that patients with an abnormal result see an endocrinologist and undergo a second test, either one of the above or, in some cases, a serum midnight cortisol or dexamethasone-CRH test. Patients with concordant abnormal results should undergo testing for the cause of Cushing's syndrome. Patients with concordant normal results should not undergo further evaluation. We recommend additional testing in patients with discordant results, normal responses suspected of cyclic hypercortisolism, or initially normal responses who accumulate additional features over time.

UR - http://www.scopus.com/inward/record.url?scp=43249095400&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=43249095400&partnerID=8YFLogxK

U2 - 10.1210/jc.2008-0125

DO - 10.1210/jc.2008-0125

M3 - Article

C2 - 18334580

AN - SCOPUS:43249095400

VL - 93

SP - 1526

EP - 1540

JO - Journal of Clinical Endocrinology and Metabolism

JF - Journal of Clinical Endocrinology and Metabolism

SN - 0021-972X

IS - 5

ER -