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Cushing syndrome evaluation — ABIM Board MCQ

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HardEndocrinology/MetabolismCushing syndrome evaluationABIM Board

A 39-year-old woman has weight gain, proximal muscle weakness, new hypertension, bruising, and wide purple striae. She is not taking glucocorticoids. Morning cortisol is 19 mcg/dL. Which of the following is the most appropriate diagnostic study?

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Correct answer: A — Late-night salivary cortisol or overnight dexamethasone suppression testing

Initial testing for suspected Cushing syndrome uses tests that assess loss of normal cortisol regulation, such as late-night salivary cortisol, 1-mg overnight dexamethasone suppression, or 24-hour urinary free cortisol. Random morning cortisol is not a screening test.

Reference: Endocrine Society Cushing Syndrome Guideline