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Laboratorial Diagnosis of Cushing’s Syndrome: Differential Diagnosis Among the Different Causes of ACTH-Dependent and ACTH-Independent Cushing’s Syndrome

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Cushing's Syndrome

Part of the book series: Contemporary Endocrinology ((COE))

Summary

Once the diagnosis of Cushing’s syndrome is established, it is imperative to differentiate among the various possible causes. The first step is to differentiate between adrenocorticotropic hormone (ACTH)-independent and ACTH-dependent causes. This is readily achieved by the determination of ACTH levels by an immunometric assay. Low ACTH levels are suggestive of an adrenal cause, which can be readily identified by abdominal imaging studies. On the other hand, the differential diagnosis of ACTH-dependent Cushing syndrome can be very challenging, as clinical and laboratorial manifestations of Cushing’s disease (CD) and ectopic ACTH syndrome (EAS) are usually very similar. In order to differentiate between the two etiologies, many non-invasive dynamic tests have been proposed. Unfortunately, all these tests have limitations. The gold-standard in differentiating CD from EAS is the bilateral inferior petrosal sinus sampling, but this test is laborious and not readily available. The correct diagnosis is achieved by a composite of clinical, laboratorial and imaging studies allied to a precise clinical judgment. The following chapter describes how laboratorial tests can help in differentiating among the many etiologies of Cushing’s syndrome. The most used laboratorial tools, its advantages and limitations are briefly presented.

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Authors and Affiliations

  1. Division of Endocrinology and Metabolism, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brasil

    Antonio M. Lerário MD & Marcello D. Bronstein MD

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  2. Marcello D. Bronstein MD
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  1. , Division of Endocrinology and Metabolism, Hospital das Clínicas, University of Sao, Sao Paulo, 05403-000, Brazil

    Marcello D. Bronstein

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Lerário, A.M., Bronstein, M.D. (2010). Laboratorial Diagnosis of Cushing’s Syndrome: Differential Diagnosis Among the Different Causes of ACTH-Dependent and ACTH-Independent Cushing’s Syndrome. In: Bronstein, M. (eds) Cushing's Syndrome. Contemporary Endocrinology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60327-449-4_7

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  • DOI: https://doi.org/10.1007/978-1-60327-449-4_7

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