Diagnosing Cushing's Syndrome, Blood Tests, Scans, X-Rays and Reasons for Each. Initial Screening: First-Line Biochemical Tests. In healthy individuals, the level of serum cortisol reaches a peak in... Low-Dose Dexamethasone Suppression test. In contrast to normal subjects, patients with Cushing's. Diagnosing Cushing syndrome can be complex and difficult. This syndrome is easier to recognize once it develops fully, but healthcare providers try to diagnose and treat it before it gets to that point. No single test can definitively diagnose the condition, so healthcare providers often use several steps to diagnose Cushing syndrome Diagnosis of Cushing's syndrome is based on a review of your medical history, physical examination and laboratory tests, which help to determine the presence of excess levels of cortisol. Often X-ray exams of the adrenal or pituitary glands are useful for locating tumors The most important decision in the diagnosis of Cushing syndrome is deciding which patients need to begin a diagnostic evaluation. With the growing epidemic of obesity and metabolic syndrome (central obesity with hypertension and insulin resistance), many patients have a Cushingoid phenotype, but most do not have Cushing syndrome
Endogenous Cushing's syndrome (CS) is a rare disease, and usually characterized by hypertension, diabetes, obesity, osteoporosis, facial rounding, dorsocervical fat pad, thin skin, purple striae, hirsutism, and mood disorders. Efficient diagnostic and screening strategies lead to the diagnosis of a significantly higher number of cases of CS The most common cause of Cushing's syndrome is iatrogenic from medically prescribed corticosteroids. Excess cortisol production may be caused by either excess adrenocorticotropic hormone (ACTH) secretion (from a pituitary or other ectopic tumor) or independent adrenal overproduction of cortisol. The diagnosis can be challenging in mild cases The diagnostic approach to patients with suspected Cushing's syndrome has been published in an evidence-based guideline by the Endocrine Society. Three diagnostic studies are currently recommended: late-night salivary cortisol, 24 hour urine free cortisol, low-dose dexamethasone suppression
Doctors may use urine, saliva, or blood tests to diagnose Cushing's syndrome. Sometimes doctors run a follow-up test to find out if excess cortisol is caused by Cushing's syndrome or has a different cause. No one test is perfect, so doctors usually do two of the following tests to confirm a diagnosis: 24-hour urinary free-cortisol tes Cushing syndrome is the clinical manifestation of pathological hypercortisolism from any cause. Patients often display weight gain with central obesity, facial rounding and plethora, proximal muscle weakness, and thinning of the skin. They also develop metabolic complications including diabetes mellitus, dyslipidaemia, metabolic bone disease, and. The diagnosis of Cushing's syndrome is critically dependent on the quality and performance of cortisol assays, be they from serum, saliva, or urine and measured by RIA, ELISA, or LC-MS/MS. Clinicians need a greater appreciation of the robustness (or otherwise) of their particular assay and its variance from published cutoff data Cushing's syndrome can sometimes be difficult to diagnose, especially since the symptoms of Cushing's syndrome can mimic other conditions, such as metabolic syndrome. Often times, several tests are needed to confirm a Cushing's syndrome diagnosis—and your doctor will want to rule out other conditions
As a result, doctors use laboratory tests to help diagnose Cushing's syndrome and, if that diagnosis is made, go on to determine whether it is caused by Cushing's disease or not. These tests determine if too much cortisol is made spontaneously, or if the normal control of hormones isn't working properly Too much cortisol can cause some of the hallmark signs of Cushing syndrome — a fatty hump between your shoulders, a rounded face, and pink or purple stretch marks on your skin. Cushing syndrome can also result in high blood pressure, bone loss and, on occasion, type 2 diabetes Cushing syndrome (CS) is a constellation of clinical signs and symptoms resulting from chronic exposure to excess cortisol, either exogenous or endogenous. Exogenous CS is most commonly caused by administration of glucocorticoids There are other tests used for the diagnosis of Cushing's disease such as the dexamethasone suppression and corticotropin-releasing hormone ( CRH ) stimulation tests. However, these are not as reliable in distinguishing between the causes as IPSS. A doctor may want to do multiple tests to confirm the results
Symptoms of Cushing's syndrome Increased hair and stria in a person with medication-induced Cushing's syndrome Features of Cushing syndrome including a round face, acne, reddish skin, central obesity, and poor muscle tone Symptoms include rapid weight gain, particularly of the trunk and face with sparing of the limbs (central obesity) Tests and diagnosis. Your doctor may suspect Cushing's syndrome if you have typical symptoms and are taking steroid medicine. If you're not taking steroids, it can be difficult to diagnose because the symptoms can be similar to other conditions. If Cushing's syndrome is suspected, the amount of cortisol in your body can be measured in your: urine; bloo Cushing syndrome is caused by prolonged exposure to high circulating levels of cortisol. The most common cause of cushingoid features is iatrogenic corticosteroid use, while some herbal preparations can also increase circulating corticosteroid levels leading to Cushing syndrome. Cushing syndrome can be interchangeably called hypercortisolism How is Cushing syndrome diagnosed? Cushing syndrome is a complex disease, and diagnosis may often be difficult. Tests used to measure cortisol levels have varying sensitivity levels and detect excess levels of cortisol using different methods. Also, cortisol levels naturally rise and fall throughout the day and night based on the sleep-wake cycle. This fluctuation in cortisol may make it challenging to determine whether cortisol levels are higher than they should be
Cushing's syndrome is a diagnostic challenging endocrinous entity. Many laboratorial examinations are available for the study of these patients. Available examinations are not absolutely trustworthy for its diagnosis, so that, very often, it is necessary to conjúgate informations from different labo The diagnosis of Cushing syndrome is often confirmed by obtaining several salivary cortisol levels and obtaining a 24-hour UFC level or performing a low-dose dexamethasone suppression test. If. Cyclic Cushing's syndrome (also known as intermittent or periodic) is a disease characterized by periods of transient hypercortisolemia shifting into periods of normo- and/or hypocortisolemia. Diagnosis of cyclic Cushing's syndrome is based on at least three periods of confirmed hypercortisolemia interspersed by two periods of. Cushing's syndrome has general symptoms that are similar to several other health conditions and, as a result, it can be difficult to diagnose. It is often a long process that requires a series. Cushing's syndrome: update of diagnosis and management. Mayo Clinic Proc. 1986;61:49-58. 3. Orth DN. Cushing's syndrome. N Engl J Med. 1995;332:791-803 [Published erratum appears in N Engl J.
Cushing syndrome is caused by chronic exposure to excessive glucocorticoids and can result in diverse manifestations ranging from subclinical, cyclical, or mild to rapid-onset severe variants 1,2,3,4; excessive concentrations of circulating free glucocorticoid can result from either 1,2,3,4. exogenous pharmacologic doses of corticosteroid C ushing 's syndrome (CS) is caused by prolonged supraphysiological levels of circulating cortisol. Cushing's disease (CD) is the most common etiology (70%-80% of CS cases) of endogenous CS. It is caused by a pituitary adenoma that secretes adrenocorticotropic hormone (ACTH), which stimulates secretion of cortisol by the adrenal glands Cushing Syndrome is a hormonal disorder caused by high levels of the hormone cortisol in the body. Find top treatment options, what causes it and more Cushing's syndrome is a disorder of the endocrine system. Cushing's syndrome (Cushing's disease, Hypercortisolism, Adrenal Hyperfunction) is a cluster of clinical abnormalities caused by excessive levels of adrenocortical hormones (particularly cortisol) or related corticosteroids and, to a lesser extent, androgens and aldosterone If your symptoms still can't be explained, your doctor may decide to test for Cushing's syndrome by measuring your cortisol levels. If your cortisol levels are high, then it is important to determine the source of the problem so that it can be treated properly. If the source is due to a pituitary tumor, then the diagnosis is Cushing's disease
ACTH Measurements Patients with adrenal causes of Cushing's syndrome have low blood ACTH levels and patients with the other causes of Cushing's syndrome have normal or high levels. A doctor can diagnose too much ACTH by measuring its level in the blood. Inferior Petrosal Sinus Sampling (IPSS The diagnosis of Cushing's syndrome must be established before any attempt at differential diagnosis, since the tests employed in the differential diagnosis may be misleading, or uninterpretable, unless there is biochemical confirmation of the hypercortisolemic state. This latter criterion is vital and applicable to all of the tests detailed.
Cushing's syndrome is a collection of signs and symptoms due to prolonged exposure to glucocorticoids such as cortisol. Signs and symptoms may include high blood pressure, abdominal obesity but with thin arms and legs, reddish stretch marks, a round red face, a fat lump between the shoulders, weak muscles, weak bones, acne, and fragile skin that heals poorly Individuals diagnosed with Cushing syndrome are at a higher risk of death compared to the general population. The morbidity and mortality of Cushing syndrome are primarily due to the effects of related conditions such as diabetes, hypertension, heart disease, obesity, and osteoporosis with fractures Terminology. Cushing disease refers to glucocorticoid excess solely due to an adrenocorticotropic hormone-secreting pituitary adenoma, while Cushing syndrome encompasses all etiologies of glucocorticoid excess 6.. Clinical presentation. Typically, patients have the following clinical features 6:. rounded face, sometimes described as 'moon-shaped Diagnosis and Differential Diagnosis of Cushing's Syndrome. List of authors. D. Lynn Loriaux, M.D., Ph.D. April 13, 2017. N Engl J Med 2017; 376:1451-1459. DOI: 10.1056/NEJMra1505550. Editors. During a physical exam, a doctor will look for tell-tale signs of Cushing's syndrome, such as a 'moon face', buffalo hump, purplish-pink stretch marks, thinning skin or bruises. One of the main signs which will be used to make a diagnosis is a measurement of cortisol levels in the body. A diagnosis may only be made after several.
Animated Mnemonics (Picmonic): https://www.picmonic.com/viphookup/medicosis/ - With Picmonic, get your life back by studying less and remembering more. M.. The diagnosis of Cushing syndrome (CS) can be challenging. It remains to be determined which diagnostic tests are the most accurate. Objective. To summarize the accuracy of diagnostic tests for CS using contemporary meta-analytic techniques (hierarchical models). Data Sources
Pituitary Cushing's syndrome (Cushing's disease) is the most common cause of Cushing's syndrome, and stems from hyperplasia of both adrenal glands caused by over stimulation by adrenocorticotropic hormone (ACTH), usually from pituitary adenoma. The syndrome mostly affects women between ages 20 and 40 Cushing Syndrome / Disease. A 61-year-old obese man with well-controlled hypertension on a diuretic, hyperlipidemia, diabetes and current smoker (35 pack-year history) presents to his primary care physician for fatigue. He also notes that he has been having increasing cough, shortness of breath, and poor appetite Cushing syndrome is a group of signs and symptoms caused by abnormally high levels of cortisol (hypercortisolism). Cortisol is produced by the outer layer of the adrenal glands, called the cortex. Cortisol is a steroid hormone that breaks down fat and protein and stimulates liver glucose production
Laboratory Testing for Cushing Syndrome A single laboratory test is insufficient to diagnose Cushing Syndrome, and more than one test is the standard. Cortisol levels vary throughout the day, meaning that a singular blood sample for cortisol is not accurate. Testing is, therefore, conducted in two stages Raff H, Carroll T. Cushing's syndrome: from physiological principles to diagnosis and clinical care. J Physiol. 2015;593(3):493-506. Fleseriu M, Hamrahian AH, Hoffman AR, Kelly DF, Katznelson L; for AACE Neuroendocrine and Pituitary Scientific Committee Cushing syndrome diagnosis How is Cushing syndrome diagnosed? The diagnosis is made based on the level of cortisol in the body. Laboratory testing and blood works should be done to come up with the most accurate diagnosis. Some of the diagnostic procedures include: A 24-hour urinary free cortisol test (8 The dexamethasone-suppression test is commonly used in the diagnosis of Cushing's syndrome. This test was developed by Grant Liddle in the early 1960s as a differential diagnostic test to separate corticotropin-dependent from corticotropin-independent Cushing's syndrome. This is now done by measuring the plasma corticotropin level
Diagnosis and treatment. A diagnosis of Cushing syndrome is often confirmed by the presence of high levels of cortisol in the serum, saliva, or urine. The different causes of Cushing syndrome are distinguished from one another by measurements of serum ACTH and serum cortisol concentrations before and after the administration of dexamethasone Cushing syndrome, named after the famous neurosurgeon, Harvey Cushing who first described it, is an endocrine disorder with elevated cortisol levels in the blood. In some cases, Cushing syndrome results from a pituitary adenoma making excess ACTH, and in those situations it's called Cushing disease. Normally, the hypothalamus, which is located at the base of the brain, secretes corticotropin.
Part I: Criteria for Diagnosis and Cure of Cushing's Syndrome (CS) Endogenous CS results from chronic exposure to excess glucocorticoids produced by the adrenal cortex. It may be caused by excess ACTH production (80-85%), usually by a pituitary corticotroph adenoma [Cushing's disease (CD)], less frequently by an extrapituitary tumor. The diagnosis of Cushing's syndrome can be difficult and requires close collaboration with the laboratory. Patients with Cushing's syndrome, particularly those with malignant tumours secreting adrenocorticotrophic hormone (ACTH), often present with a hypokalaemic alkalosis. There are two phases in the investigation; firstly establishing the. Cyclic Cushing's syndrome (also known as intermittent or periodic) is a disease characterized by periods of transient hypercortisolemia shifting into periods of normo- and/or hypocortisolemia. Diagnosis of cyclic Cushing's syndrome is based on at least three periods of confirmed hypercortisolemia interspersed by two periods of normocortisolemia
Once Cushing's syndrome is diagnosed, the cause should be identified to decide/determine a specific treatment. Sustained excess of cortisol leads to CRH and ACTH suppression from healthy corticotroph cells . Thus, the first step in the differential diagnosis of Cushing's syndrome is measurement of plasma ACTH Causes and Diagnosis. If Cushing's syndrome is suspected on the basis of the patient's physical appearance, the diagnostic workup should include a thorough medical history, physical exam, and 1 or more of the following tests to establish hypercortisolism: the 24-hour urinary cortisol test, the low-dose dexamethasone suppression test, or the late-night salivary cortisol test
Cushing's syndrome: from physiological principles to diagnosis and clinical care. Raff H, Carroll T. J Physiol. 2015 Feb 1;593(3):493-506 Published on Jan 13, 201 A complete history and physical examination are critical in determining the pretest likelihood of a diagnosis of Cushing syndrome. Patients present with a wide range of clinical features , 2 and no single symptom is necessary to the diagnosis. A high positive likelihood ratio (LR) for Cushing syndrome has been found in the presence of. Diagnosis Banding. Diagnosis banding Cushing disease adalah penyakit yang memiliki kadar kortisol yang tinggi. Walaupun sulit, klinisi harus dapat membedakan Cushing disease dan penyebab hiperkortisolisme lainnya. Pada penggunaan glukokortikoid eksogen kronis, umumnya akan muncul tanda dan gejala yang sama dengan Cushing disease
Please use one of the following formats to cite this article in your essay, paper or report: APA. Smith, Yolanda. (2019, February 26). Diagnostic du syndrome de Cushing Diagnosis of Cushing's syndrome Prior to performing any laboratory investigations a comprehensive drug history should be taken in order to eliminate the use of exogenous glucocorticoids. The 2008 Endocrine Society Clinical Practice Guideline for the diagnosis of Cushing's syndrome recommends screenin
Cushing's syndrome is a debilitating endocrine disorder characterized by excessive cortisol levels in the blood which may be the result of a tumor of the pituitary gland, adrenal glands (located above the kidneys) or from tumors or cancer arising elsewhere in the body (ectopic ACTH producing tumors) Diagnosis of Cushing's Syndrome Date of Review: 15 October 18 diagnosis-of-cushing's-syndrome.pdf 413 KB. Download. Authors. Helen Wiggins. Return to listing. The Association for Clinical Biochemistry and Laboratory Medicine 130-132 Tooley Street, London, SE1 2TU Facebook; Twitter; 020 7403 8001. Diagnosis of Cushing's syndrome (CS) and identification of the aetiology of hypercortisolism can be challenging. The Endocrine Society clinical practice guidelines recommends one of the four tests for initial screening of CS, namely, urinary-free cortisol, late night salivary cortisol, overnight dexamethasone suppression test or a longer low-dose dexamethasone suppression test, for 48 hours Cushing syndrome diagnosis. Cushing syndrome can be difficult to diagnose, particularly endogenous Cushing syndrome, because other conditions share the same signs and symptoms. Diagnosing Cushing syndrome can be a long and extensive process. You may not have any firm answers about your condition until you've had a series of medical appointments Cushing's syndrome and Cushing's disease are serious conditions. Without treatment, they can be fatal. However, if a person has a proper diagnosis in good time, surgical or medical treatment.
Symptoms can often suggest a diagnosis of Cushing syndrome, but certain tests are required to provide a definitive diagnosis. The goal of testing is to identify high cortisol levels. Such tests include: Salivary cortisol levels—This test involves swabbing the mouth for saliva and then measuring the cortisol levels in that sample Cushing disease is Cushing syndrome that results from excess pituitary production of adrenocorticotropic hormone (ACTH), generally secondary to a pituitary adenoma. Typical symptoms and signs include moon face and truncal obesity, easy bruising, and thin arms and legs. Diagnosis is by history of receiving corticosteroids or by finding elevated. Cushing's syndrome or hypercortisolism is a disorder characterized by features resulting from chronic exposure to excess glucocorticoids. Cushing's syndrome may be exogenous, due to chronic glucocorticoid intake, or endogenous, due to increased adrenal secretion of cortisol or adrenocorticotropic hormone (ACTH) production from the pituitary gland or ectopic sources Diagnostisering av Cushings syndrom. Veterinærer som mistenker Cushings syndrom vil ta blodprøver for å bekrefte diagnosen. Det er også anbefalt å ta blodprøver for vurdering av hundens generelle helse. Kortisolkonsentrasjonen i blodet varierer mye iløpet dagen, både hos friske hunder og hunder med Cushings syndrom. Dette er grunnen til.
The higher the index, the higher the likelihood of a diagnosis of Cushing's syndrome being correct. On the basis of a study of 159 people, signs that have the best discriminatory value are easy bruising (62% of cases, discriminant index 10.3), objective muscle weakness (56%, 8.0), plethora (94%, 3.0), and purple striae (56%, 2.5). 9 Absence. Cushing's Syndrome: Epidemiology • Disorder of chronic excess of cortisol in endogenous Cushing's and synthetic glucocorticoid in exogenous • Endogenous disease is rare: Incidence: 1-10 patients per million per year • Cushingoid states due to exogenous steroid use are highly prevalent • Difficulty and delay in diagnosis Cushing syndrome is a constellation of clinical abnormalities caused by chronic high blood levels of cortisol or related corticosteroids.Cushing disease is Cushing syndrome that results from excess pituitary production of adrenocorticotropic hormone (ACTH), generally secondary to a pituitary adenoma. Typical symptoms and signs include moon face and truncal obesity, easy bruising, and thin arms.
The diagnosis of Cushing's syndrome must be es- tablished before any attempt at differential diagnosis, since the tests employed in the differential diagnosis may be mis Cushing's syndrome refers to the diagnosed medical condition of elevated cortisol levels in the body. This encompasses all causes for the increased values. In the case of Cushing's disease however, abnormal cells collect in the pituitary gland and form a tumor. This tumor releases excessive amounts of ACTH (adrenocorticotropic hormone)
physiology, diagnosis, differential diagnosis, and treatment of Cushing's syndrome. Only through a thorough understanding of the physiology of the system can one properly diagnose and care for patients with Cushing's syndrome. Conversely, understanding the pathophysiology of Cushing's syndrome illuminates the normal control of the HPA axis Diagnosis Who Should Be Tested ES recommends obtaining a thorough drug history to exclude excessive exogenous glucocorticoid exposure leading to iatrogenic Cushing's syndrome before conducting biochemical testing (1|⊕⊕⊕⊕). ES recommends testing for Cushing's syndrome in the following groups: • Patients with unusual features for age (e.g., osteoporosis, hypertension) (Table 1 The diagnosis of Cushing syndrome due to endogenous overproduction of cortisol requires the demonstration of inappropriately high serum or urine cortisol levels, as shown in the algorithm below. Currently, 4 methods are accepted for the diagnosis of Cushing syndrome: urinary free cortisol level, low-dose dexamethasone suppression test, evening. Diagnosing Cushing's Syndrome. Since the signs and symptoms of Cushing's syndrome involve progressive body changes, it may be difficult to know when to see your physician. The most common sign, especially when using corticosteroid medications to treat other conditions such as arthritis, inflammatory bowel disease, asthma, et cetera, is.
Cushing disease and Cushing syndrome Twenty-four hour urine is collected for free cortisol. Usually 2 baseline values are obtained. Dexamethasone suppression test: The physiological basis of this. Diagnostic Considerations. Diagnosis of Cushing syndrome can sometimes be very challenging, especially in cases of pseudo-Cushing, subclinical, mild or cyclic Cushing syndrome. A pseudo-Cushing is defined as having some of the clinical features and biochemical evidence of Cushing syndrome. However, resolution of the primary condition results in. Cushing syndrome (CS) refers to the complex of signs and symptoms resulting from prolonged supraphysiological levels of circulating glucocorticoids of any type. CS may occur at any age; the disease may be caused by endogenous factors, such as tumors releasing glucocorticoids in an uncontrolled manner, or the exogenous administration of glucocorticoids Cushing's syndrome can occur during pregnancy without obvious signs and symptoms specific to the condition, a new case report shows, suggesting the disease should be considered as a diagnosis in cases of high blood pressure during early pregnancy.. The case report, A case of subclinical Cushing's syndrome in pregnancy with superimposed preeclampsia, was published in Clinical Case.
Cushing's syndrome occurs when your dog's body makes too much of a hormone called cortisol. This chemical helps them to respond to stress, control their weight, fight infections, and keep their blood sugar levels under control. But too much or too little can cause problems. Cushing's, also known as hypercortisolism and hyperadrenocorticism, can be Cushing's Syndrome- Causes. For as long as it has been described, Cushing's syndrome has presented physicians with a problem. Harvey Cushing first described it in 1932, and the diagnosis, differential diagnosis and. The Cushing's Syndrome: Diagnosis Pocket Guide is based on the latest guidelines of The Endocrine Society and was developed with their collaboration. This practical quick-reference tool contains evidence-graded recommendations for evaluation of Cushing's syndrome including differential diagnosis and a testing algorithm. Spiral-bound 8 Pages 80# Diamond Silk Cover with Satin Aqueous Coating.
Cushing syndrome is a rare disorder caused by having high levels of cortisol over a long time. It's caused by a tumor on the pituitary gland or adrenal gland, or taking some kinds of medicine. Cushing syndrome may cause excess weight, slow growth, and problems with sexual development. Treatment may include medicines or surgery Cushing's syndrome, caused by the body making too much cortisol, is rare. About 5 in 1 million people develop this type of Cushing's syndrome each year. Most cases are in people aged between 20 and 50. Women are five times more commonly affected than men. The rest of this leaflet is about Cushing's syndrome due to the body making too much cortisol Cushing Syndrome: Diagnostic Workup and Imaging Features, With Clinical and Pathologic Correlation Nicolaus A. Wagner-Bartak 1 , Ali Baiomy 1 , Mouhammed Amir Habra 2 , Shalini V. Mukhi 3 , Ajaykumar C. Morani 1 , Brinda R. Korivi 1 , Steven G. Waguespack 2 and Khaled M. Elsayes Cushing disease is a specific type of Cushing syndrome. It occurs when a pituitary tumor causes the body to make too much cortisol. Cushing disease is the most common form of endogenous (from the body) Cushing syndrome, and makes up about 70% of Cushing syndrome cases
Cushing's syndrome is fairly rare. Pituitary ACTH hypersecretion or Cushing disease is cause of cushing's syndrome which is due to the increased secretion of (ACTH) adrenocorticotropic hormone from the anterior pituitary. Some patients have cushing syndrome because the adrenal glands have a tumor making too much cortisol The Diagnosis of Cushing's syndrome: An Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology and Metabolism. 2008;93:1526-40. 12. Newell-Price J, Trainer P, Besser M, Grossman A. The diagnosis and differential diagnosis of Cushing's syndrome and pseudo-Cushing's states. Endocr Rev. 1998;19(5):647-72. 13 In Cushing's disease, the 24-hour urine free cortisol (UFC) levels are typically at least four to five times greater than normal. Your doctor may need two or more elevated 24-hour UFC tests to confirm the diagnose Cushing's syndrome. Uncommonly, Cushing's disease can come and go (periodic Cushing's disease), requiring multiple 24-hour UFC tests For the most part, exogenous Cushing's syndrome presents with the same signs and symptoms as spontaneous Cushing's syndrome. There are nevertheless a few important differences in presentation [2]. Many patients who develop iatrogenic Cushing's syndrome do so after receiving high doses of steroid over long periods of time