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Difficulty with Cyclic Cushing’s Diagnosis

Question: There seems to be some controversy about Cyclic Cushing’s – some doctors don’t even believe in it.  Many patients get frustrated because they “chase highs” hoping to test during an active period and, in a worst case scenario, spend many months or even years getting worse while trying to test only during periods when they don’t feel good and associate that with high cortisol.  Do you have any advice for these patients?

Answer: Cyclic Cushing’s syndrome is very rare. Patients have episodic cushingoid manifestations (weight gain, easy bruising, increased blood pressure or glucose, muscle weakness or fatigue) associated with abnormal cortisol testing. The episodes usually last for several weeks. In between episodes, patients do not have these manifestations and cortisol tests are normal.  Making the diagnosis is difficult and requires multiple measurements of 24-hour urine cortisol and bedtime salivary cortisol.  If patients do not feel good or feel their health deteriorates despite normal cortisol testing, other causes should be investigated.

By Dr. Adriana Ioachimescu, Emory University Hospital, Atlanta, GA (Winter-Spring 2018)

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