The diagnosis of Cushing's syndrome - Atypical presentations and laboratory shortcomings

In the last 3 decades, there have been several advances in understanding th e pathogenesis of Gushing's syndrome and in testing for the diagnosis and d ifferential diagnosis of its various forms. Advanced diagnostic techniques provide useful tools in discovering ectopic adrenocorticotropic hormone sou rces. However, the occurrence of unusual clinical presentations, laboratory shortcomings, and exogenous compound interference may lead to wrong conclu sions. This article reviews the atypical presentations of hypercortisolism and some laboratory shortcomings that may confuse the diagnosis of Gushing' s syndrome. Comments and suggestions are given with the aim of helping the clinician avoid diagnostic mistakes.