Cushing Syndrome - Causes, Symptoms, Diagnosis, Treatment & Diagnostic Workup - USMLE

Cushing Syndrome - Causes, Symptoms, Diagnosis, Treatment & Diagnostic Workup - USMLE

Cushing Syndrome & Cushing disease are highly tested topics in exams. cushing syndrome Diagnostic workup & diagnostic alogritham are fully explained in this video.it also explains symptoms, causes, and pathophysiology of cushing disease and cushing syndrome.Cushing syndrome can be treated when its appropriate cause has been found out by its diagnostic workup.
The diagnosis of Cushing syndrome requires demonstration of inappropriately high level of cortisol in the serum or urine. The levels should be measured when cortisol, according to its physiologic circadian rhythm, is supposed to be suppressed, that is, late evening or when a patient is given exogenous glucocorticoids.

This concept gives rise to the following tests, which have been recommended as screening tests for Cushing syndrome:

Midnight serum or salivary cortisol
24-hour urine free cortisol
Low dose dexamethasone suppression test
Exogenous glucocorticoid use around time of testing must be addressed and excluded to ensure the accuracy of the test result's interpretation.

Urinary free cortisol (UFC) determination has been widely used as an initial screening tool for Cushing syndrome because it provides measurement of cortisol over a 24-hour period. A valid result depends on adequate collection of the specimen. Urinary creatinine excretion can be used to assess the reliability of the collection. 24-Hour urine creatinine excretion should be 20-25 mg/kg (lean body weight) in adult males younger than 50 years of age and 15-20 mg/kg (lean body weight) in adult females younger than 50 years. However, in elderly patients, creatinine excretion gradually declines over time, which makes this estimation less accurate than that for younger individuals. Urine free cortisol values higher than 3 times the upper limit of normal are highly suggestive of Cushing syndrome. Values higher than the normal reference range but less than 3times the upper limit of normal are inconclusive. Values within this range may indicate pseudo–Cushing syndrome or Cushing syndrome and require further testing. Multiple collections are necessary because patients with disease may have values that fall within the normal range. #CushingSyndrome #Cushingdisease
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