GuidelinesEML (Adult Hospital STG)
Cushing Syndrome
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2019 Edition
ICD-10 Code: E24.0-4/E24.8-9
DESCRIPTION
- Cushing syndrome is an illness resulting from excess cortisol secretion or exogenous glucocorticoid administration.
- Cushing disease is hypercortisolism secondary to an ACTH-secreting pituitary tumour.
Investigations
Low dose overnight dexamethasone suppression test (or when unavailable, betamethasone 1 mg equivalent to dexamethasone 1 mg).
- Dexamethasone, oral, 1 mg.
- Administer at 23:00.
- Measure plasma cortisol at 8:00, the next morning after breakfast.
- In people with normal pituitary and adrenal function morning cortisol will be suppressed to <50 nmol/L.
- Refer if cortisol levels >50 nmol/L.
GENERAL MEASURES
- Check for hypertension and diabetes and treat accordingly.
- Check potassium.
REFERRAL
All cases for investigation of aetiology and appropriate management.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2024 Edition