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New Cushing's Syndrome Guideline Published

Practice guideline reflects Endocrine Society's goal of improving detection and diagnosis

WEDNESDAY, April 30 (HealthDay News) -- A new clinical practice guideline will improve physicians' ability to detect and diagnose Cushing's syndrome, according to an article published in the May issue of the Journal of Clinical Endocrinology & Metabolism.

Lynnette K. Nieman M.D., of the National Institutes of Health in Bethesda, Md., and colleagues were appointed to a Task Force by the Clinical Guidelines Subcommittee of The Endocrine Society to conduct a systematic evidence-based review and develop a guideline, which was subsequently reviewed and approved by The Endocrine Society's Clinical Guidelines Subcommittee and Clinical Affairs Core Committee, members responding to a Web posting, and The Endocrine Society Council.

The Task Force recommends that, after exogenous glucocorticoid use has been excluded, patients with multiple and progressive features consistent with Cushing's syndrome, particularly those with a high discriminatory value, should be tested. They also recommend testing for Cushing's syndrome in patients with adrenal incidentaloma.

"We recommend initial use of one test with high diagnostic accuracy (urine cortisol, late-night salivary cortisol, 1-mg overnight or 2-mg 48-hour dexamethasone suppression test)," the authors write. "We recommend that patients with an abnormal result see an endocrinologist and undergo a second test, either one of the above or, in some cases, a serum midnight cortisol or dexamethasone-CRH test. Patients with concordant abnormal results should undergo testing for the cause of Cushing's syndrome. Patients with concordant normal results should not undergo further evaluation."

The study authors report financial relationships with the pharmaceutical industry.

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