Cushing Syndrome: Maybe Not So Uncommon of a Disease
Cushing Syndrome: Maybe Not So Uncommon of a Disease
Recognition of CS and the identification of the underlying cause are often challenging. Even more challenging is the decision about whom to screen in the primary care setting. To date, evidence-based guidelines for screening criteria are missing. The Endocrine Society clinical practice guidelines recommend testing for CS in patients with multiple signs and symptoms compatible with the syndrome. In addition to the treatment guidelines, patients in high-risk groups such as those with poorly controlled diabetes, hypertension, and early-onset osteoporosis (particularly with fractures) have been shown to have a high prevalence of subclinical (mostly ACTH-independent) CS. The issue of whether it is cost-effective to screen these groups of patients is still unresolved. Testing should be done in patients who are incidentally discovered to have an adrenal mass. Only a small percentage of these will turn out to have CS. Efficient biochemical screening tests represent the most valuable tool to diagnose the disease. Once diagnosed, the first-line treatment strategy is surgery to remove the tumor. However, because surgery is not effective in all patients with CD, additional treatment is needed and can include repeat surgery, radiation therapy, and medical therapy.
Conclusions
Recognition of CS and the identification of the underlying cause are often challenging. Even more challenging is the decision about whom to screen in the primary care setting. To date, evidence-based guidelines for screening criteria are missing. The Endocrine Society clinical practice guidelines recommend testing for CS in patients with multiple signs and symptoms compatible with the syndrome. In addition to the treatment guidelines, patients in high-risk groups such as those with poorly controlled diabetes, hypertension, and early-onset osteoporosis (particularly with fractures) have been shown to have a high prevalence of subclinical (mostly ACTH-independent) CS. The issue of whether it is cost-effective to screen these groups of patients is still unresolved. Testing should be done in patients who are incidentally discovered to have an adrenal mass. Only a small percentage of these will turn out to have CS. Efficient biochemical screening tests represent the most valuable tool to diagnose the disease. Once diagnosed, the first-line treatment strategy is surgery to remove the tumor. However, because surgery is not effective in all patients with CD, additional treatment is needed and can include repeat surgery, radiation therapy, and medical therapy.
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