Abstract
Cushing's syndrome is a rare entity, and a high index of suspicion is needed for screening in a primary care setting. The clinical awareness of the primary care physician (PCP) to the highly indicative signs and symptoms such as facial plethora, proximal myopathy, reddish purple striae, and easy bruisability should alert him to look for biochemical evidence of Cushing's syndrome through any of the first-line screening tests, namely, 24-hour urinary free cortisol, overnight dexamethasone suppression test, or late-night salivary cortisol. Commonly used random cortisol measurements are unreliable; hence, general practitioners are encouraged to understand the use of these more reliable tests with increased sensitivity and specificity for screening Cushing's syndrome. In this write-up, we set out to increase awareness about the presentation of Cushing's syndrome and current recommended screening methods as well as their strengths and weaknesses. We relied mainly on the recommendations by the Endocrine Society Guidelines.
Highlights
Cushing’s syndrome (CS) describes the sign and symptom complex due as a result of prolonged supraphysiological levels of circulating glucocorticoid of any type [1]
In pseudo Cushing’s syndrome, there is physiologic hypercortisolism in the absence of true CS [1, 2]. Such situations may be found in pregnancy, depression, alcohol dependence, obesity, poorly controlled diabetes, physical stress, malnutrition, anorexia nervosa, strenuous exercise, and hypothalamic amenorrhoea; a broader list is presented in Table 1 [1, 2]
The clinical awareness of the primary care physician to the highly indicative signs and symptoms such as facial plethora, proximal myopathy, reddish purple striae, and easy bruisability should alert him to look for biochemical evidence of CS through any of the first-line screening tests, that is, 24-hour urinary free cortisol (UFC), ODST, or late-night salivary cortisol
Summary
Cushing’s syndrome (CS) describes the sign and symptom complex due as a result of prolonged supraphysiological levels of circulating glucocorticoid of any type [1]. CS can be exogenous (iatrogenic) or endogenous [1]. Exogenous CS represents the bulk of CS which are due as a result of medically prescribed glucocorticoids as well as steroid-containing skin bleaching creams especially in Africa [2,3,4]. Endogenous CS is diagnosed when there is increased adrenocorticotropic hormone (ACTH) from a pituitary adenoma (Cushing’s disease) or an ectopic source as well as an independent adrenal source of cortisol over production [1]. The discussions from here will focus mainly on endogenous CS
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