Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2014) 34 N1.1 | DOI: 10.1530/endoabs.34.N1.1

SFEBES2014 Nurse Session Cushing's Syndrome (4 abstracts)

Investigating and diagnosing Cushing’s syndrome: not as straightforward as it seems?

Karim Meeran


Imperial College, London, UK.


Cushing’s syndrome is rare at about 20 per million of population each year. Patients with Cushing’s syndrome complain of increased weight, high blood pressure and diabetes. Obesity not caused by Cushing’s is becoming very much more common, and obesity itself can also cause high blood pressure and diabetes. Distinguishing common simple obesity from rare Cushing’s disease can be difficult. Patients with simple obesity are now able to surf the internet, and find forums about obesity and Cushing’s syndrome. Some patients with Cushing’s syndrome correctly put the nightmare of their story onto such discussion forums. The diagnosis may not have been considered for some time. They complain that no one thought of the diagnosis, and are annoyed with doctors, nurses and any other medical staff that they feel should have picked it up.

Patients with simple obesity who do not actually have Cushing’s, but are desperate to lose weight might believe they actually have Cushing’s, especially if they also have hypertension and diabetes. Large numbers of such people ask for the tests for Cushing’s disease, and some might be convinced that their Cushing’s has been missed, when in fact they don’t have it at all, but seek several opinions until someone says they have Cushing’s. No test is 100% accurate. There are several tests that can be used to screen for Cushing’s syndrome. If the false positive rate for whatever screening test you perform is 1%, and you test 100 people, then one normal person might be told that he or she has Cushing’s wrongly. However we are now testing thousands of normal obese patients, and with a 1% false positive rate, for every 1000 people tested, ten will be told they have Cushing’s when they don’t. Thus the accuracy of the test changes when you start doing it in large numbers of normal people. It is crucial that we do not remove the pituitary gland of normal people and for this reason it is essential that more tests are carried out to be certain of the diagnosis before operating. Sadly there are a some patients with simple obesity who believe they have Cushing’s syndrome and continue to seek opinions until they are told they have Cushing’s on one of the tests. Having had some tests that suggest they don’t have Cushing’s, but one that does, these individuals choose to ignore all the ‘normal’ tests, and only believe the abnormal one. These individuals do not lose weight when they have had pituitary surgery. It is essential that screening test are not carried out for simple obesity, but that investigations for Cushing’s are reserved for patients who have several clinical features of Cushing’s such as proximal myopathy which is not present in most patients with simple obesity.

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