Diagnosis of Cushing‘s Syndrome

Cushing’s syndrome or hypercortisolism is a condition when your body produces too much of the cortisol hormone. People suffering from asthma or rheumatoid arthritis are more prone to Cushing’s syndrome. As per the estimates, 70% of the people who have Cushing’s syndrome are women or who are assigned female at birth.

What is the Diagnosis of Cushing Syndrome?

For Cushing’s syndrome diagnosis, the physician will ask the patient to undergo several tests. The healthcare provider will look at the person’s medical history, and perform some examinations and lab tests to accurately determine the health situation. The doctor may ask for the following tests to be done:

1. 24-hour urinary cortisol test - Your healthcare provider will ask you to get a 24-hour analysis of your urine where the amount of cortisol in micrograms will be analysed.
2. Midnight salivary cortisol test - Your cortisol levels are determined through this test. It is estimated that cortisol levels are low during the night between 11 pm to 12 am. If the test reveals that your cortisol levels are high you are suffering from Cushing’s syndrome.
3. Blood tests - Your doctor will also ask you to get a blood test done. Through the blood test, the ACTH levels in the blood are measured. It is estimated that if the ACTH levels are low then you might be suffering from an adrenal tumour, and on the other hand, if the levels are normal or high then you could be suffering from a pituitary or ectopic tumour.
4. High-dose dexamethasone suppression test - This test is performed only if your ACTH levels and cortisol levels in the morning are high. This test is done to know the source of Cushing’s syndrome. It helps to identify pituitary adenoma (Cushing’s disease) and a tumour in the body.

Once your healthcare provider confirms Cushing’s syndrome, they will proceed to identify its underlying cause. Typically, this condition arises from medication use or the presence of a tumour. If you are currently taking glucocorticoids, it's likely the medication is responsible. In this case, the doctor will consider reducing the dosage. In cases where you are not on glucocorticoids, the suspicion shifts toward the presence of a tumour. The tumour could be in the adrenal glands, pituitary gland, or elsewhere. To pinpoint the tumour's location, your healthcare provider may recommend specific imaging studies:

1. CT scan (CT) or MRI of the abdomen: These scans are used to detect tumours in the adrenal glands and can be performed with or without IV contrast, offering high sensitivity.
2. Pituitary MRI: This imaging technique focuses on the pituitary gland to identify potential tumours. However, it may not always yield a definitive diagnosis; approximately 50% of Cushing syndrome cases display normal MRI results, while 10% have unrelated tumours.
3. Bilateral inferior petrosal sinus sampling (BIPPS): BIPPS helps locate the source of ACTH secretion. It boasts an impressive accuracy rate of 95% to 98%.
4. Chest CT scan: If there is suspicion of an ectopic tumour, a chest CT scan will be ordered to investigate the possibility of lung cancer

Conclusion

Cushing’s syndrome pathophysiology involves an unusual increase in the hormone cortisol, which ultimately leads to abnormal heart rhythm. It causes weakness, dizziness, loss of muscle mass, high blood pressure, fatigue, etc. There are varying treatment options for the condition, such as surgery, medicines, chemotherapy, and radiation therapy. It is advised to have a health insurance policy to handle financial distress in times of medical crisis.  

Disclaimer: The information provided in this blog is for educational and informational purposes only. It is not intended as a substitute for professional advice, diagnosis, or treatment. Please consult your general physician or another certified medical professional for any questions regarding a medical condition. Relying on any information provided in this blog is solely at your own risk, and ICICI Lombard is not responsible for any effects or consequences resulting from the use of the information shared.