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    A commentary on Diagnosing Cushing’s disease in the context of renal failure

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    Author
    Raff, H.
    Cohen, E.P.
    Findling, J.W.
    Date
    2019
    Journal
    European Journal of Endocrinology
    Publisher
    BioScientifica Ltd.
    Type
    Article
    
    Metadata
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    See at
    https://doi.org/10.1530/EJE-19-0560
    Abstract
    The diagnosis of endogenous hypercortisolism (Cushing's syndrome) is extremely challenging. Chronic kidney disease (CKD) increases the activity of the hypothalamic-pituitary-adrenal axis making the diagnosis of Cushing's syndrome even more challenging. This is particularly so since urine free cortisol (UFC) testing is not useful in CKD. The case report by Stroud et al. in this issue of the European Journal of Endocrinology highlights this problem by finding normal UFC in a patient with pituitary ACTH-dependent Cushing's syndrome. Elevated late-night salivary cortisol (LNSC) testing was diagnostic and pituitary adenomectomy was curative. LNSC measurement is the diagnostic test of choice in patients with suspected Cushing's syndrome, particularly in the presence of CKD.
    Keyword
    late-night salivary cortisol testing
    Cushing Syndrome--diagnosis
    Renal Insufficiency
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85072229843&doi=10.1530%2fEJE-19-0560&partnerID=40&md5=bbf94c5ef821c73a53ad8bcfe483ad41; http://hdl.handle.net/10713/11007
    ae974a485f413a2113503eed53cd6c53
    10.1530/EJE-19-0560
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