Cushing’s syndrome is the resultant clinical phenotype consequent on chronic glucocorticoid excess. The most common cause of Cushing’s syndrome is exposure to exogenous glucocorticoids in the treatment of chronic inflammatory and malignant conditions. In contrast, endogenous Cushing’s syndrome is rare, occurring in around one to two individuals per million population a year. Untreated Cushing’s syndrome is associated with significant complications, and a 5-year mortality rate in the region of 50 %. The excess mortality relates primarily to vascular and infective causes. Early identification and appropriate diagnosis is essential to providing the patient an optimal outcome. Treatment of endogenous Cushing’s syndrome is dependent on identification of the aetiology, which may be pituitary, adrenal or ectopic. A number of tests are available for diagnosis, and identifying the aetiology, but all are subject to false positive and false negative results, placing weight upon clinical suspicion of the disease. Cushing’s syndrome should therefore be managed exclusively by individuals with extensive experience with this condition. Treatment is generally surgical and directed at the cause. Although surgery is highly successful, medical therapy where remission is not achieved can leave the physician wanting.
KeywordsCushing’s syndrome Cushing’s disease Pseudo-Cushing’s Dexamethasone suppression test Inferior petrosal sinus sampling Corticotropin releasing hormone (CRH) Adrenocorticotrophin hormone (ACTH)
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