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Tests and diagnosis
By Mayo Clinic staffCushing syndrome can be difficult to diagnose, particularly endogenous Cushing syndrome, because other conditions share the same signs and symptoms.
Your doctor will conduct a physical exam, looking for signs of Cushing syndrome. He or she may suspect Cushing syndrome if you have signs such as rounding of the face (moon face), a pad of fatty tissue between the shoulders and neck (buffalo hump), and thin skin with bruises and stretch marks.
If you've been taking a corticosteroid medication for a long time, your doctor may suspect that you've developed Cushing syndrome as a result of this medication. If you haven't been using a corticosteroid medication, these diagnostic tests may help pinpoint the cause:
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Urine and blood tests. These tests measure hormone levels in your urine and blood and show whether your body is producing excessive cortisol. For the urine test, you may be asked to collect your urine over a 24-hour period. Both the urine and blood samples will be sent to a laboratory to be analyzed for cortisol levels.
Your doctor might also recommend other specialized tests that evaluate the blood and urine to help determine if Cushing syndrome is present and to help identify the underlying source of any excess production. These tests often involve measuring cortisol levels before and after stimulation or suppression with other hormone medications.
- Saliva test. Cortisol levels normally rise and fall throughout the day. In people without Cushing syndrome, levels of cortisol drop significantly in the evening. By analyzing cortisol levels from a small sample of saliva collected late at night, doctors can see if cortisol levels are too high, suggesting a diagnosis of Cushing syndrome.
- Imaging tests. Computerized tomography scans or magnetic resonance imaging scans can provide images of your pituitary and adrenal glands to detect abnormalities, such as tumors.
As these tests help your doctor diagnose Cushing syndrome, they may also rule out medical conditions with similar signs and symptoms. For example, polycystic ovary syndrome — a hormone disorder in women with enlarged ovaries — shares some of the same signs and symptoms as Cushing has, such as excessive hair growth and irregular menstrual periods. Depression, eating disorders and alcoholism also can partially mimic Cushing syndrome.
- Stratakis CA. Cushing syndrome in pediatrics. Endocrinology Metabolism Clinics of North America. 2012;41:793.
- Wein AJ, et al. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. http://www.mdconsult.com/das/book/body/208746819-6/0/1445/0.html. Accessed Jan. 2, 2013.
- Guaraldi F, et al. Cushing syndrome: Maybe not so uncommon of an endocrine disease. Journal of the American Board of Family Medicine. 2012;25:199.
- Mazziotti G, et al. Diabetes in Cushing syndrome: Basic and clinical aspects. Trends in Endocrinology and Metabolism. 2011;22:499.
- Nieman LK. Overview of the treatment of Cushing's syndrome. http://www.uptodate.com/home. Accessed Jan. 1, 2013.
- Kliegman RM, et al. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa.: Saunders Elsevier; 2011. http://www.mdconsult.com/das/book/body/208746819-6/0/1608/0.html. Accessed Jan. 2, 2013.
- Cushing's syndrome. National Institute of Diabetes and Digestive and Kidney Diseases. http://www.endocrine.niddk.nih.gov/pubs/cushings/cushings.aspx. Accessed Jan. 2, 2013.
- Nieman LK. Causes and pathophysiology of Cushing's syndrome. http://www.uptodate.com/home. Accessed Jan. 1, 2013.
- The Surgeon General's report on bone health and osteoporosis: What it means to you. National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/health_info/bone/SGR/surgeon_generals_report.asp. Accessed Jan. 2, 2013.
- Nippoldt TB (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 24, 2013.
- FDA approves Korlym for patients with endogenous Cushing's syndrome. U.S. Food and Drug Administration. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm292462.htm. Accessed Jan. 25, 2013.
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