[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-25911-105":59,"doc-detail-25911-en":114},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":106,"head_meta":109,"extra_data":111,"updated_unix":113},105,"en","cushings-syndrome-management-and-diagnosis","Cushing’s Syndrome Management and Diagnosis","","Cushing’s syndrome, characterized by excess cortisol secretion, poses a high mortality risk if left untreated. Differentiating between true Cushing’s and pseudo-Cushing’s is critical, with the latter involving reversible physiological hyperactivation of the hypothalamic-pituitary-adrenal (HPA) axis. Pseudo-Cushing states are associated with neuropsychiatric disorders, polycystic ovary syndrome (PCOS), obesity, alcohol abuse, and eating disorders, often presenting with a loss of diurnal rhythm and lack of low-dose dexamethasone suppressibility. Severe depression can complicate diagnosis, as it may also be a feature of Cushing’s syndrome itself. Exogenous Cushing’s is most commonly iatrogenic due to prolonged synthetic glucocorticoid administration, while endogenous causes require further investigation. Diagnostic confirmation begins with measuring serum cortisol, typically between 0800-0900 hours. Levels below 100 nmol/l may suggest exogenous Cushing’s. Levels between 100-350 nmol/l might indicate exogenous Cushing’s with a recovering HPA axis. Levels exceeding 350 nmol/l necessitate further testing. For diagnosis confirmation, the high-dose dexamethasone suppression test (HDDST) is employed, where serum cortisol is measured before and after 48 hours of 2 mg dexamethasone administration four times daily. A reduction in cortisol by less than 50% from baseline suggests ectopic ACTH syndrome, whereas a reduction greater than 50% points towards pituitary-dependent disease. Inferior petrosal sinus sampling (IPSS) with ACTH measurement is the gold standard for confirming Cushing’s disease, unless a pituitary MRI reveals a tumor larger than 6 mm. Radiological assessments, including MRI for pituitary microadenomas (detecting around 60%) and CT or MRI for adrenal tumors (with adrenal carcinomas typically being large and malignant), aid in identifying the source of excess cortisol. It is crucial to discontinue estrogen-containing medications for 6 weeks prior to investigations to ensure normal corticosteroid-binding globulin (CBG) levels and avoid false-positive results, as most cortisol assays measure total cortisol. Dexamethasone is used in suppression testing due to its lack of cross-reactivity in cortisol immunoassays. Potential limitations include false-positive results due to poor dexamethasone absorption or hepatic enzyme induction, and false-negative values, which are common in obese or hospitalized patients.",{"@graph":69,"@context":105},[70,84],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/cushings-syndrome-management-and-diagnosis/25911/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/cushings-syndrome-management-and-diagnosis/25911.png","ImageObject",300,407,{"name":92,"@type":93},"Violet","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-09-21","2026-05-07",true,{"@type":102,"interactionType":103,"userInteractionCount":19},"InteractionCounter",{"@type":104},"ViewAction","https://schema.org",{"og:url":107,"og:type":108,"og:title":65,"og:site_name":95,"og:description":67},"https://docshare.wps.com/document/cushings-syndrome-management-and-diagnosis/25911","article",{"robots":110,"canonical":107},"index,follow",{"doc_id":112,"site_id":62},25911,1778195215,{"code":4,"msg":5,"data":115},{"doc_id":112,"user_id":116,"nickname":92,"user_avatar":117,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":66,"file_id":118,"file_url":119,"file_type":120,"file_size":121,"view_count":19,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":122,"language":123,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":66,"faqs":66,"seo_title":124,"seo_description":67,"update_tm":113,"read_time":125},4398048950312,"https://ap-avatar.wpscdn.com/avatar/400002538284de19e3c?_k=1778320343897328908","cbCaiaIze83rvgQq","https://ap.wps.com/l/cbCaiaIze83rvgQq","pdf",20214350,26,"English","Cushing’s Syndrome Management and Diagnosis | PDF",66]