Cushing syndrome
Who to screen for endogenous hypercortisolism, which screening tests to use and what upsets them, how ACTH splits pituitary, ectopic and adrenal causes, and first-line surgery, medical therapy and the traps after cure.
Tier 2Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Exogenous glucocorticoid is by far the commonest cause. Take a careful drug history first, including inhaled, topical and injected steroids and CYP3A4 inhibitor interactions (see Glucocorticoid therapy complications).
- Endogenous Cushing syndrome is rare (2 to 3 per million a year) but over-represented in people with resistant hypertension, early osteoporosis and adrenal incidentalomas.
- Screen only when there is real suspicion. Confirm with two different abnormal tests, then use ACTH to localise.
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Sources
- The diagnosis of Cushing's syndrome: an Endocrine Society clinical practice guidelineEndocrine Society (Nieman et al., J Clin Endocrinol Metab 2008;93:1526-40), 2008
- Treatment of Cushing's syndrome: an Endocrine Society clinical practice guidelineEndocrine Society (Nieman et al., J Clin Endocrinol Metab 2015;100:2807-31), 2015
- Consensus on diagnosis and management of Cushing's disease: a guideline updatePituitary Society (Fleseriu et al., Lancet Diabetes Endocrinol 2021;9:847-75), 2021
- Management of adrenal incidentalomas: European Society of Endocrinology clinical practice guideline in collaboration with the European Network for the Study of Adrenal TumorsESE and ENSAT (Fassnacht et al., Eur J Endocrinol 2023;189:G1-G42), 2023
- Osilodrostat (Isturisa): PBS medicine status, Cushing syndromeAU/NZPharmaceutical Benefits Scheme, 2025
- Osilodrostat 1 mg (PBS Schedule item 14714K, endogenous Cushing syndrome, Authority Required)AU/NZPharmaceutical Benefits Scheme, Checked November 2026
- Endocrinology (Therapeutic Guidelines)AU/NZTherapeutic Guidelines Ltd
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy