Cushing syndrome evaluation
Treatment options in Shanghai

Depending on the clinical context, doctors may use late-night salivary cortisol, a 24-hour urinary free cortisol measurement or a dexamethasone suppression test. They examine different aspects of cortisol production and regulation; they are not interchangeable with a random blood result. No single test is perfect, and further or repeated testing may be needed, particularly when findings disagree or symptoms fluctuate. Ask how samples should be collected and which medicines or circumstances the team needs to account for. Follow the laboratory and prescriber's instructions rather than adapting medication yourself to obtain a more normal result.

Cushing disease specifically refers to a pituitary source driving excess ACTH; Cushing syndrome is the broader term and can have other causes. After biochemical assessment supports the diagnosis, ACTH and selected imaging help distinguish pituitary, adrenal or ectopic sources. A pituitary or adrenal image alone does not replace that endocrine reasoning. Further specialised testing is sometimes needed when the findings do not fit together. Ask the team to explain the sequence: what has been established, which source is suspected and what the next test can distinguish. This can prevent premature commitment to surgery based only on an image.

Management of medicine-related cortisol excess differs from management of a hormone-producing tumour. Where a tumour is responsible, surgery, medicines that control cortisol or other treatments may be considered according to its source and individual circumstances. At the same time, blood pressure, glucose, bone health and infection-related problems may need care. Reducing prescribed steroids must be supervised because abrupt withdrawal can be harmful and the original illness still needs treatment. Even after successful treatment of the source, hormone replacement or ongoing endocrine follow-up may be necessary. An operation is therefore not the end of the hormonal management plan.