Lambert et al listed criteria for the diagnosis of Cushing’s Disease. The authors are from Mount Sinai Medical Center in New York City.


Criteria of Cushing’s syndrome:

(1) clinical phenotype of Cushing syndrome

(2) one or more of the following:

(2a) elevated 24-hour urine free cortisol concentration

(2b) lack of serum cortisol suppression overnight after 1 mg dexamethasone administration (serum cortisol > 5 µg/dL)

(2c) elevated midnight salivary free cortisol


Criteria for identifying a pituitary source – one or more of the following:

(1) (pituitary adenoma on MRI) AND (after removal of the adenoma the serum cortisol < 5 µg/dL after 1 mg overnight dexamethasone suppression)

(2) (pituitary adenoma on MRI) AND (histologic evidence of corticotropin production in the adenoma)

(3) bilateral inferior petrosal sinus sampling (BIPSS) shows a central to peripheral ratio in serum ACTH concentration > 3:1


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