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International Journal of Endocrinology
Volume 2017, Article ID 1547358, 6 pages
https://doi.org/10.1155/2017/1547358
Review Article

Screening for Cushing Syndrome at the Primary Care Level: What Every General Practitioner Must Know

1Endocrine & Diabetes Unit, Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
2Directorate of Medicine, Endocrine and Diabetes Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana

Correspondence should be addressed to Ernest Yorke; moc.oohay@muivolvap

Received 29 May 2017; Revised 4 July 2017; Accepted 11 July 2017; Published 27 July 2017

Academic Editor: Franco Veglio

Copyright © 2017 Ernest Yorke et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Cushing’s syndrome is a rare entity, and a high index of suspicion is needed for screening in a primary care setting. The clinical awareness of the primary care physician (PCP) to the highly indicative signs and symptoms such as facial plethora, proximal myopathy, reddish purple striae, and easy bruisability should alert him to look for biochemical evidence of Cushing’s syndrome through any of the first-line screening tests, namely, 24-hour urinary free cortisol, overnight dexamethasone suppression test, or late-night salivary cortisol. Commonly used random cortisol measurements are unreliable; hence, general practitioners are encouraged to understand the use of these more reliable tests with increased sensitivity and specificity for screening Cushing’s syndrome. In this write-up, we set out to increase awareness about the presentation of Cushing’s syndrome and current recommended screening methods as well as their strengths and weaknesses. We relied mainly on the recommendations by the Endocrine Society Guidelines.