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The Diagnosis and Differential Diagnosis of Cushing’s Syndrome and Pseudo-Cushing’s States

Department of Endocrinology, St. Bartholomew’s Hospital, West Smithfield, London, EC1A 7BE, United Kingdom

I. Introduction

II. Definitions and Etiology

III. Diagnostic Overview

IV. Clinical Features

V. Biochemical Diagnosis of Cushing’s Syndrome

A. Cardinal features

B. Urinary free cortisol (UFC)

C. Low-dose dexamethasone testing

D. Circadian rhythm assessment

E. Cyclical Cushing’s syndrome

VI. ACTH-Dependent vs. ACTH-Independent Cushing’s Syndrome

VII. Differential Diagnosis of ACTH-Dependent Cushing’s Syndrome

A. Overview

B. Basal testing

C. Dynamic noninvasive testing

D. Invasive testing

VIII. Other Causes of Cushing’s Syndrome

IX. Imaging

A. Pituitary

B. Adrenal

C. Ectopic secretion

X. Differentiation from Pseudo-Cushing’s States

XI. Conclusions