Screening for Cushing's syndrome: is it worthwhile?

Pituitary. 2015 Apr;18(2):201-5. doi: 10.1007/s11102-015-0634-9.

Abstract

Introduction: Cushing's syndrome (CS) is a rare disease characterized by a collection of signs and symptoms, also common in the general population without elevated cortisol secretion. During the last years more patients with CS are identified earlier and with milder disease. Many of these patients are diagnosed during screening efforts performed for certain or isolated complaints like weight gain, diabetes mellitus (DM), hypertension, osteoporosis, elevated white blood cell counts and more.

Methods: In this review article the most popular screening test performed in the studies cited was the 1-mg dexamethasone suppression test.

Conclusions: Cushing is not frequent enough to support the use of routine screening in patients with morbid obesity and type 2 DM. Also only 1% of hypertensive patients have secondary hypertension due to CS. However, screening should be considered in young patients with resistant DM and/or hypertension. Among patients with osteoporosis and vertebral fractures up to 5% were diagnosed with subclinical hypercortisolism; most of these had adrenal adenoma. Screening for CS is important in subjects with adrenal incidentaloma, and many studies show a high prevalence (~10%) of Cushing or subclinical CS in these patients.

Publication types

  • Review

MeSH terms

  • ACTH-Secreting Pituitary Adenoma / diagnosis*
  • ACTH-Secreting Pituitary Adenoma / epidemiology
  • ACTH-Secreting Pituitary Adenoma / therapy
  • Adenoma / diagnosis*
  • Adenoma / epidemiology
  • Adenoma / therapy
  • Adrenal Cortex Function Tests*
  • Comorbidity
  • Dexamethasone / administration & dosage*
  • Humans
  • Mass Screening / methods*
  • Patient Selection
  • Pituitary ACTH Hypersecretion / diagnosis*
  • Pituitary ACTH Hypersecretion / epidemiology
  • Pituitary ACTH Hypersecretion / therapy
  • Predictive Value of Tests
  • Prognosis
  • Risk Assessment
  • Risk Factors

Substances

  • Dexamethasone