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Consensus on Biomarker Utility for ACTH-Dependent Cushing's Syndrome: A Pituitary Society Modified Delphi Panel
Maria Fleseriu1, Beverly Mk Biller2, Irina Bancos3
1Oregon Health & Science University, Portland, OR, USA.
The Journal of Clinical Endocrinology and Metabolism
|July 16, 2026
Summary
Experts reached consensus on using late-night salivary cortisol for diagnosing mild Cushing
Area of Science:
- Endocrinology
- Clinical Biochemistry
Background:
- Biochemical tests are crucial for diagnosing and managing Cushing's syndrome (CS).
- Emerging research necessitates updated consensus on biomarker utility in CS.
- Adrenocorticotropic hormone-dependent CS requires current diagnostic and monitoring guidelines.
Purpose of the Study:
- To establish an updated consensus on biomarkers for diagnosing and monitoring adrenocorticotropic hormone-dependent CS.
- To discuss novel therapeutic strategies for CS.
- To identify future research priorities in CS.
Main Methods:
- A modified two-round Delphi panel involving 41 international experts.
- Consensus defined as ≥70% agreement for Likert-scale statements or option selection.
- An eight-member Steering Committee guided statement development.
Main Results:
- Consensus was reached on 45% of statements in Round 1 and 44% in Round 2.
- Most panelists utilize late-night salivary cortisol for diagnosing mild CS and monitoring treatment.
- Block-and-replace therapies are considered for cyclical or severe CS; restoring circadian rhythm is a treatment goal.
Conclusions:
- Presents areas of expert alignment on CS diagnosis and monitoring.
- Findings aim to support clinical decision-making in CS management.
- Highlights priority areas for future research in Cushing's syndrome.
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