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Policy Reference: Cushing Syndrome Guideline Issue: 1: Version 3
Author Job Title: STATUS: FINAL
Peter Prinsloo Consultant Chemical Pathologist
Change record
Date Author Description Change
Record
June 2000 Peter Prinsloo New Policy Version 1
Nigel Lawson
August 2005 Peter Prinsloo Reviewed with minor word Version 2
changes
Baseline Investigations
FBC, ESR
U&E, blood glucose, liver function tests,
Bone markers
LH, FSH, E2, Testosterone
Thyroid function tests
Prolactin
CXR / Abdominal USS / Abdominal CT scan depending on biochemistry and haematology
results
Confirmation of Hypercortisolism
Patient takes 1mg of dexamethasone (2mg if patient morbidly obese) orally at 23h00.
Sample: Collect 5ml clotted blood (red top) at 09h00.
Please mark card clearly Dexamethasone Suppression Test
A plasma cortisol > 50nmol/L at 09h00 indicate the patient may have Cushings syndrome
and that further studies (high dose dexamethasone suppression test etc) are indicated.
If hypercortisolism has been confirmed, or is still suspected, you are advised to contact either
the Duty Biochemist or Consultant Endocrinologist to identify the aetiology or perform more
diagnostic tests.
References
1) Disorders of Adrenal Cortex. Baillieres Clinical Endocrinology and Metabolism 1992;
6(1): 41-55
2) Cushings Syndrome. Ross RJ, Trainer PJ. Clinical Endocrinology 1998; 49: 153-155
3) The Role of the Laboratory in the Diagnosis of Cushings syndrome. Perry LA,
Grossman AB. Annals of Clinical Biochemistry 1997; 34: 345-359
Disclaimer: These guidelines have been registered with the Trust. However, clinical
guidelines are guidelines only. The interpretation and application of the clinical guidelines will
remain the responsibility of the individual clinician. If in doubt contact a senior colleague or
expert. Caution is advised when using guidelines after the review date.