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Disclaimer
is pocket guide attempts to define principles of practice that should produce high-quality patient
care. It focuses on the needs of primary care practice, but also is applicable to providers at all levels.
is pocket guide should not be considered exclusive of other methods of care reasonably directed at
obtaining the same results. e ultimate judgment concerning the propriety of any course of conduct
must be made by the clinician aer consideration of each individual patient situation. Neither IGC,
the medical associations, nor the authors endorse any product or service associated with the distributor
of this clinical reference tool.
Source
Nieman LK, Biller BMK, Findling JW, Newell-Price J, Savage MO, Stewart PM, Montori VM.
e Diagnosis of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline. J Clin
Endocrinol Metab. May 2008, 93(5):1526–1540.
Abbreviations
ACTH, adrenocorticotropic hormone; CBG, cortisol-binding globulin; CS, Cushing's
syndrome; Dex-CRH; dexamethasone-suppressed corticotropin-releasing hormone; DST,
dexamethasone suppression test; HPA, hypothalamic-pituitary-adrenal; HPLC, high-
performance liquid chromatography; 11β-HSD2; 11β-hydroxysteroid dehydrogenase
type 2; LC-MS/MS, tandem mass spectrometry; LDDST, low-dose DST; 17OHCS,
17-hydroxycorticosteroid; SMR, standard mortality ratio; UFC, urine free cortisol
Grading System
Strength of
Recommendation
1 = strong 2 = conditional UGPS = ungraded good
practice statement
Quality of
Evidence
⊕⊕⊕⊕
= high
⊕⊕⊕
= moderate
⊕⊕
= low
⊕
= very low
