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NOTTINGHAM UNIVERSITY HOSPITALS NHS TRUST: Clinical Chemistry Guidelines

Investigation for possible Cushings syndrome

Document Information
Policy Reference: Cushing Syndrome Guideline Issue: 1: Version 3
Author Job Title: STATUS: FINAL
Peter Prinsloo Consultant Chemical Pathologist

First Issued On:


June 2000
Latest Reissue Date: Review Date:
July 2013 July 2016
(Or sooner if necessary)
Document Derivation: Consultation Process:
Peer reviewed
See references
Ratified By: Distribution:
Department of Clinical Pathology Clinical Pathology Website
Department of Diabetes and Endocrinology

Change record
Date Author Description Change
Record
June 2000 Peter Prinsloo New Policy Version 1
Nigel Lawson
August 2005 Peter Prinsloo Reviewed with minor word Version 2
changes

August 2005 Peter Prinsloo Reviewed with minor word Version 3


changes

Created on 18/07/2013 Page 1 of 3


NOTTINGHAM UNIVERSITY HOSPITALS NHS TRUST: Clinical Chemistry Guidelines

Cushings Syndrome Guideline


Clinical Features

Truncal obesity, thinning of skin, purple striae


Moon face and plethoric cheeks
Excessive bruising
Hirsutism in females
Skin pigmentation, acne
Hypertension
Glucose intolerance
Psychiatric disturbances

Causes of Cushings syndrome

Corticosteroid or ACTH treatment


Pituitary hypersecretion of ACTH (Cushings disease)
Adrenal adenoma/carcinoma
Ectopic ACTH production e.g. bronchus carcinoma, carcinoid

Baseline Investigations

FBC, ESR
U&E, blood glucose, liver function tests,
Bone markers
LH, FSH, E2, Testosterone
Thyroid function tests
Prolactin
CXR / Abdominal USS / Abdominal CT scan depending on biochemistry and haematology
results

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NOTTINGHAM UNIVERSITY HOSPITALS NHS TRUST: Clinical Chemistry Guidelines

Confirmation of Hypercortisolism

Overnight Dexamethasone Suppression Test

Patient takes 1mg of dexamethasone (2mg if patient morbidly obese) orally at 23h00.
Sample: Collect 5ml clotted blood (red top) at 09h00.
Please mark card clearly Dexamethasone Suppression Test
A plasma cortisol > 50nmol/L at 09h00 indicate the patient may have Cushings syndrome
and that further studies (high dose dexamethasone suppression test etc) are indicated.

If hypercortisolism has been confirmed, or is still suspected, you are advised to contact either
the Duty Biochemist or Consultant Endocrinologist to identify the aetiology or perform more
diagnostic tests.

References
1) Disorders of Adrenal Cortex. Baillieres Clinical Endocrinology and Metabolism 1992;
6(1): 41-55
2) Cushings Syndrome. Ross RJ, Trainer PJ. Clinical Endocrinology 1998; 49: 153-155
3) The Role of the Laboratory in the Diagnosis of Cushings syndrome. Perry LA,
Grossman AB. Annals of Clinical Biochemistry 1997; 34: 345-359

Disclaimer: These guidelines have been registered with the Trust. However, clinical
guidelines are guidelines only. The interpretation and application of the clinical guidelines will
remain the responsibility of the individual clinician. If in doubt contact a senior colleague or
expert. Caution is advised when using guidelines after the review date.

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