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Establishing the diagnosis of Cushing's syndrome

Lynnette K Nieman, MD
Section Editor
André Lacroix, MD
Deputy Editor
Kathryn A Martin, MD


The possible presence of Cushing's syndrome (CS) is suggested by certain symptoms and signs. Unfortunately, none of these are pathognomonic, and many are nonspecific (eg, obesity, hypertension, menstrual irregularity, and glucose intolerance). As a result, the diagnosis must be confirmed by biochemical tests.

The laboratory diagnostic evaluation to determine if the patient has hypercortisolism (CS) will be reviewed here. The approach to the differential diagnosis of established hypercortisolism is discussed separately. (See "Establishing the cause of Cushing's syndrome".)


Who should be tested? — We suggest testing for hypercortisolism in patients in whom a diagnosis is most likely, including the following (table 1) [1,2]:

Unusual findings for their age (osteoporosis or hypertension in young adults)

Multiple progressive features of Cushing's syndrome (CS), particularly those that are predictive of CS such as facial plethora, proximal myopathy, striae (>1 cm wide and red/purple), and easy bruising

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Literature review current through: Nov 2017. | This topic last updated: Sep 29, 2017.
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