Nieman Lynnette K, Biller Beverly M K, Findling James W, Newell-Price John, Savage Martin O, Stewart Paul M, Montori Victor M
Program on Reproductive and Adult Endocrinology, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA.
J Clin Endocrinol Metab. 2008 May;93(5):1526-40. doi: 10.1210/jc.2008-0125. Epub 2008 Mar 11.
The objective of the study was to develop clinical practice guidelines for the diagnosis of Cushing's syndrome.
The Task Force included a chair, selected by the Clinical Guidelines Subcommittee (CGS) of The Endocrine Society, five additional experts, a methodologist, and a medical writer. The Task Force received no corporate funding or remuneration.
Consensus was guided by systematic reviews of evidence and discussions. The guidelines were reviewed and approved sequentially by The Endocrine Society's CGS and Clinical Affairs Core Committee, members responding to a web posting, and The Endocrine Society Council. At each stage the Task Force incorporated needed changes in response to written comments.
After excluding exogenous glucocorticoid use, we recommend testing for Cushing's syndrome in patients with multiple and progressive features compatible with the syndrome, particularly those with a high discriminatory value, and patients with adrenal incidentaloma. We recommend initial use of one test with high diagnostic accuracy (urine cortisol, late night salivary cortisol, 1 mg overnight or 2 mg 48-h dexamethasone suppression test). We recommend that patients with an abnormal result see an endocrinologist and undergo a second test, either one of the above or, in some cases, a serum midnight cortisol or dexamethasone-CRH test. Patients with concordant abnormal results should undergo testing for the cause of Cushing's syndrome. Patients with concordant normal results should not undergo further evaluation. We recommend additional testing in patients with discordant results, normal responses suspected of cyclic hypercortisolism, or initially normal responses who accumulate additional features over time.
本研究的目的是制定库欣综合征诊断的临床实践指南。
特别工作组包括一名由内分泌学会临床指南小组委员会（CGS）选出的主席、另外五名专家、一名方法学家和一名医学撰写人员。特别工作组未接受任何企业资助或报酬。
共识以证据的系统评价和讨论为指导。这些指南先后由内分泌学会的CGS和临床事务核心委员会、对网络发布内容做出回应的成员以及内分泌学会理事会进行审查和批准。在每个阶段，特别工作组都会根据书面意见做出必要的修改。
排除外源性糖皮质激素使用后，我们建议对具有与该综合征相符的多种进展性特征的患者，尤其是那些具有高鉴别价值的患者以及肾上腺偶发瘤患者进行库欣综合征检测。我们建议首先使用一种诊断准确性高的检测方法（尿皮质醇、午夜唾液皮质醇、1毫克过夜或2毫克48小时地塞米松抑制试验）。我们建议检测结果异常的患者就诊于内分泌科医生并接受第二次检测，可选择上述检测方法之一，或在某些情况下进行血清午夜皮质醇或地塞米松 - CRH试验。检测结果一致异常的患者应进行库欣综合征病因检测。检测结果一致正常的患者不应接受进一步评估。我们建议对检测结果不一致的患者、疑似周期性高皮质醇血症但反应正常的患者或最初反应正常但随时间出现更多特征的患者进行额外检测。
