Biochemical diagnosis of hypercortisolism: When and how?
Level 5 - mechanism / opinion, no new human data
Narrative review without systematic search or primary empirical data
PubMed 42236015 · doi:10.1016/bs.vh.2026.03.001
What was done
This narrative review outlines the clinical approach to the biochemical diagnosis of hypercortisolism (Cushing's syndrome). Based on the abstract, it examines indications for testing, protocols for initial diagnostic evaluation—specifically late-night salivary cortisol, the overnight 1 mg dexamethasone suppression test, and 24-hour urinary free cortisol—and reviews test accuracy, execution protocols, and clinical pitfalls.
What was found
The abstract reports no numerical data, diagnostic sensitivity/specificity values, or quantitative effect sizes. It qualitatively describes the core diagnostic targets: loss of normal circadian cortisol rhythm (late-night salivary cortisol), impaired glucocorticoid negative feedback (overnight dexamethasone suppression test), and elevated biologically active cortisol production (24-hour urinary free cortisol).
Why it matters
Hypercortisolism carries significant multisystem morbidity and mortality if untreated. This paper provides a structured diagnostic framework to help clinicians select, perform, and interpret initial biochemical screening tests.
Limits
The abstract describes a narrative review rather than a systematic review or prospective diagnostic accuracy study. No quantitative diagnostic metrics, comparative test performance figures, or study inclusion criteria are reported.
Cited by
- supports Cushing's syndrome is most commonly an iatrogenic condition resulting from high-dose or prolonged corticosteroid use.