Diagnosing Cushing’s syndrome can be complex and difficult. This syndrome is more easily recognized when it is fully developed, but health care providers try to diagnose and treat it well before then. No single laboratory test is perfect in diagnosing the condition, so the health care provider may try different tests.
Diagnosing Cushing’s syndrome often requires several steps. If you are being checked for Cushing’s syndrome, testing may follow this standard order1,2,3:
You will give your health care provider a complete list of all medications and other treatments you have taken to see if any of them could be responsible for raising your cortisol levels. Make certain your list includes everything containing cortisol-like compounds, such as joint or nerve injections received for pain, “tonics” and herbal medications, high doses of progesterone, and skin creams (including bleaching agents).1
You will undergo a test that measures cortisol levels, and a laboratory will check to see if the cortisol levels are normal. This test might be one of the following:
Urine samples are collected and tested several times over 24 hours.
A special device is used for collecting saliva late at night. The sample can be mailed to a laboratory or delivered to the health care provider.
This test might be called a 1 mg overnight suppression test or a 2 mg 48-hour suppression test. Several hours after you take the synthetic glucocorticoid dexamethasone by mouth, your blood level of cortisol is measured.
If your results are not normal, your health care provider may do further tests or refer you to a specialist—an endocrinologist (pronounced en-doh-kruh-NOL-uh-jist)—for the tests, which might include:
If your cortisol levels are persistently above normal and you receive a diagnosis of Cushing’s, your health care specialist will check for the cause. Tests might include the following:
If you have certain medical conditions, your health care provider may not use some of the tests listed above for reasons of safety or effectiveness. These conditions can include:
Several kinds of medications unrelated to Cushing’s syndrome may interfere with test results, but your health care provider should be aware of these drugs and know whether you are taking them.1
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