Cushing's Syndrome Screening Criteria

8AM Cortisol (µg/dL)

Screen Twice

Endocrine Society guidelines recommend at least TWO abnormal screening tests (even from the same modality) to establish a "biochemical diagnosis" of Cushing\'s Syndrome before proceeding to localization (ACTH testing/Imaging).

Guidelines & Evidence

Verified

Last Review: 2026

When to Use

Who to Screen

Patients with multiple and progressive clinical features (supraclavicular fat pad, proximal myopathy, purple striae >1cm, easy bruising, plethora).

Patients with adrenal incidentaloma (to rule out autonomous cortisol secretion).

Children with decreasing height percentile and increasing weight.

Young patients with unusual features for age (osteoporosis, hypertension).

How it Works

First-Line Tests

Test	Abnormal Threshold	Notes
1mg Overnight DST	8AM Cortisol > 1.8 µg/dL	Most sensitive. Oral contraceptives cause false positives.
24h UFC	> ULN (Upper Limit of Normal)	Needs 2 collections. CKD (eGFR < 60) decreases sensitivity.
Late-Night Salivary	> ULN (~145 ng/dL)	Loss of circadian rhythm. Needs 2 collections. Sleep patterns matter.

Last Comprehensive Review: 2026

Recent Journal Updates

Cancer MedicineJul 22, 2026

Analysis of Age, Period and Cohort Trends in Cervical In Situ and Invasive Carcinomas for Assessing the Utility of Screening Approaches—Results From the Saarland Cancer Registry

Clinical Context

We think this might be relevant to the clinical guidance for Cushing's Syndrome Screening Criteria.

JAMAJul 21, 2026

PCOS Is Now Called PMOS

Clinical Context

We think this might be relevant to the clinical guidance for Cushing's Syndrome Screening Criteria.

Alzheimers & DementiaJul 15, 2026

Age predicts Alzheimer's in Down syndrome better than MRI, plasma, or cognition

Clinical Context

We think this might be relevant to the clinical guidance for Cushing's Syndrome Screening Criteria.

Cushing's Syndrome Screening Criteria

When to Use

Who to Screen

How it Works

First-Line Tests

Clinical Pearls

Dexamethasone Pitfalls

Pseudo-Cushing's States

The Evidence

Guidelines

The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline.

Recent Journal Updates

Cushing's Syndrome Screening Criteria

When to Use

Who to Screen

How it Works

First-Line Tests

Clinical Pearls

Dexamethasone Pitfalls

Pseudo-Cushing's States

The Evidence

Guidelines

The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline.

Recent Journal Updates