Evaluation and Diagnosis

Increased Suspicion Of Hypercortisolism

The Endocrine Society Guidelines urge clinicians to increase clinical suspicion of hypercortisolism in patients who have overlapping conditions and features, such as difficult-to-control type 2 diabetes (T2D) and hypertension.1

Overlapping conditions and clinical features of Cushing syndrome*Cushing syndrome features in the general population that are common and/or less discriminatory
Symptoms
  • Depression
  • Fatigue
  • Weight gain
  • Back pain
  • Changes in appetite
  • Decreased concentration
  • Decreased libido
  • Impaired memory (especially short term)
  • Insomnia
  • Irritability
  • Menstrual abnormalities
Signs
  • Dorsocervical fat pad (“buffalo hump”)
  • Facial fullness
  • Obesity
  • Supraclavicular fullness
  • Thin skin†
  • Peripheral edema
  • Acne
  • Hirsutism or female balding
  • Poor skin healing
Overlapping conditions
  • Hypertension†
  • Incidental adrenal mass
  • Vertebral osteoporosis†
  • Polycystic ovary syndrome
  • T2D†
  • Hypokalemia
  • Kidney stones
  • Unusual infections
Features that best discriminate Cushing syndrome; most do not have a high sensitivity
  • Easy bruising
  • Facial plethora
  • Proximal myopathy (or proximal muscle weakness)
  • Striae (especially if reddish purple and >1 cm wide)

*Features are listed in random order.

†Cushing syndrome is more likely if onset of the feature is at a younger age.

Diagnosing Hypercortisolism In The Catalyst Study2

In the CATALYST study, patients with difficult-to-control T2D were identified as having hypercortisolism if they had:

  • 1-mg post-DST cortisol of >1.8 μg/dL

  • Confirmed dexamethasone level ≥140 ng/dL

The following tests were used to help identify the potential source of hypercortisolism and inform treatment decisions:

Adrenocorticotropic hormone (ACTH) test

≤15 pg/dL or 15-30 pg/dL

Dehydroepiandrosterone sulfate (DHEAS) test

≤100 μg/dL

Computed tomography (CT)

Abnormal abdominal scan

Diagnostic support is available

Referring your patient to an endocrinologist may provide additional clinical confidence in the diagnosis of hypercortisolism.1

Do you have patients who may need a hypercortisolism specialist?

FIND A SPECIALIST

Review treatment options for hypercortisolism

VIEW THE OPTIONS

Discuss the recent prevalence data with a Corcept representative

CONTACT A REP

References

1. Nieman LK, Biller BM, Findling JW, et al. J Clin Endocrinol Metab. 2008;93(5):1526-1540. doi:10.1210/jc.2008-0125 2. DeFronzo RA, Auchus RJ, Bancos I, et al. BMJ Open. 2024;14(7):e081121. doi:10.1136/bmjopen-2023-081121