The diagnostic criteria for Cushing's syndrome primarily involve a comprehensive assessment of clinical symptoms, laboratory tests, and imaging findings. Diagnosis is usually confirmed by measuring cortisol levels, performing a dexamethasone suppression test, and using imaging modalities such as CT or MRI. Cushing's syndrome is a condition caused by excessively high levels of cortisol in the body. Common causes include pituitary adenomas, adrenal tumors, or long-term use of glucocorticoids. Treatment depends on the underlying cause and may involve surgical removal of the tumor, medication, or reduction of glucocorticoid use.
1. Clinical symptoms: Typical symptoms of Cushing's syndrome include central obesity, moon face, purple striae, hypertension, diabetes, and osteoporosis. The presence of these symptoms suggests possible abnormal cortisol levels, requiring further investigation.
2. Laboratory Tests: The key to diagnosing Cushing's syndrome is testing cortisol levels. Commonly used tests include 24-hour urinary free cortisol measurement, midnight salivary cortisol measurement, and dexamethasone suppression test. In the dexamethasone suppression test, the inability of a small dose of dexamethasone to suppress cortisol secretion suggests Cushing's syndrome.
3. Imaging examinations: Imaging examinations are used to locate the cause, such as pituitary adenoma or adrenal tumor. Commonly used methods include pituitary MRI and adrenal CT. Imaging examinations help to clarify the location and extent of the lesion, providing a basis for the selection of treatment options.
4. Treatment of the underlying cause: Treatment of Cushing's syndrome depends on the cause. Cushing's syndrome caused by pituitary adenomas can be treated by surgical removal of the tumor via the transsphenoidal approach; adrenal tumors require surgical removal. For patients who cannot undergo surgery, medications such as ketoconazole and mitotane can be used to inhibit cortisol synthesis.
5. Glucocorticoid replacement therapy: After surgery or drug treatment, some patients may develop adrenal insufficiency and require glucocorticoid replacement therapy. Commonly used drugs include hydrocortisone, and the dosage needs to be adjusted according to the patient's condition.
The diagnosis and treatment of Cushing's syndrome require multidisciplinary collaboration. A comprehensive assessment of clinical symptoms, laboratory tests, and imaging findings is necessary to identify the underlying cause and implement appropriate treatment. Early diagnosis and timely treatment are crucial for improving patient prognosis. Patients should be followed up regularly to monitor cortisol levels and changes in clinical symptoms to ensure treatment effectiveness and safety.