Most people who appear to have some of the classic physical features of Cushing's Syndrome (cushingoid appearance) do not actually have the disease. After iatrogenic Cushing's is excluded, other causes of this appearance cn be polycystic ovary syndrome (androgen excess from the ovaries), ovarian tumors, congenital adrenal hyperplasia, ordinary obesity, excessive alcohol consumption, or just a family tendency to have a round face and abdomen with high blood pressure and high blood sugar. Because Cushing's Syndrome is a rare but serious disorder, it is very important to carefully exclude (rule out) other disorders and then separate the different types,. | HOW IS CUSHING S SYNDROME DIAGNOSES Most people who appear to have some of the classic physical features of Cushing s Syndrome cushingoid appearance do not actually have the disease. After iatrogenic Cushing s is excluded other causes of this appearance cn be polycystic ovary syndrome androgen excess from the ovaries ovarian tumors congenital adrenal hyperplasia ordinary obesity excessive alcohol consumption or just a family tendency to have a round face and abdomen with high blood pressure and high blood sugar. Because Cushing s Syndrome is a rare but serious disorder it is very important to carefully exclude rule out other disorders and then separate the different types leading eventually to a specific cause that can be treated. This process of testing and excluding usually takes days to weeks and requires a lot of patience and cooperation by the person being tested. After the initial history physical exam and routine blood tests the first step is to prove cortisol excess with specific blood and 24 hour urine tests for cortisol. Inappropriate cortisol production will then be evaluated by doing a dexamethasone suppression test. Dexamethasone steroid pills are given by mouth then blood and urine are collected for cortisol and other adrenal hormones. A screening test might be done initially with an overnight test but if it is abnormal usually a 4 day test divided into low and high dose dexamethasone is needed. To separate ACTH dependent from independent types a blood test for ACTH in the morning is done. Blood and urine tests for adrenal androgens are useful. Testing with other drugs such as metyrapone and CRH corticotropin releasing hormone may also be needed. Once all of the blood and urine results are analyzed they will establish whether some type of Cushing s Syndrome is present and should indicate whether the disease is ACTH dependent pituitary or ectopic or independent an adrenal tumor . Localizing techniques such as CT or MRI are then used to find the tumor.
