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

Hershel Raff1, Eric P Cohen2, James W Findling3

  • 1Departments of Medicine, Surgery, and Physiology, Medical College of Wisconsin and Endocrine Research Laboratory, Aurora St Luke's Medical Center, Aurora Research Institute, Milwaukee, Wisconsin, USA.

European Journal of Endocrinology
|July 27, 2019
PubMed

Insights

Diagnosing Cushing's syndrome is difficult, especially with chronic kidney disease (CKD). Late-night salivary cortisol (LNSC) testing is a reliable diagnostic tool, even when urine free cortisol (UFC) is not useful in CKD patients.

Area of Science:

  • Endocrinology
  • Nephrology
  • Diagnostic Medicine

Background:

  • Endogenous hypercortisolism (Cushing's syndrome) diagnosis presents significant challenges.
  • Chronic kidney disease (CKD) complicates diagnosis by altering the hypothalamic-pituitary-adrenal axis.
  • Standard urine free cortisol (UFC) testing is unreliable in patients with CKD.

Purpose of the Study:

  • To highlight the diagnostic challenges of Cushing's syndrome in patients with CKD.
  • To emphasize the utility of late-night salivary cortisol (LNSC) testing in this population.
  • To present a case illustrating the effectiveness of LNSC in diagnosing ACTH-dependent Cushing's syndrome.

Main Methods:

  • Case report analysis of a patient with pituitary ACTH-dependent Cushing's syndrome and CKD.
  • Comparison of diagnostic test results, including UFC and LNSC.
  • Evaluation of treatment outcomes following pituitary adenomectomy.

Main Results:

  • The patient presented with normal UFC levels, masking the diagnosis of Cushing's syndrome.
  • Elevated LNSC levels were diagnostic for ACTH-dependent Cushing's syndrome.
  • Pituitary adenomectomy resulted in a curative outcome.

Conclusions:

  • Late-night salivary cortisol (LNSC) measurement is the preferred diagnostic test for suspected Cushing's syndrome.
  • LNSC is particularly valuable in patients with CKD where UFC is unreliable.
  • Accurate diagnosis and timely treatment, such as surgery, are crucial for managing Cushing's syndrome.

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