Consensus on diagnosis and management of Cushing's disease: a guideline update


Maria Fleseriu, Oregon Health & Science University, Portland, OR, USA. Electronic address:
Richard Auchus, University of Michigan, Ann Arbor, MI, USA.Follow
Irina Bancos, Mayo Clinic, Rochester, MN, USA.
Anat Ben-Shlomo, Cedars-Sinai Medical Center, Los Angeles, CA, USA.Follow
Jerome Bertherat, Université de Paris, Assistance Publique-Hôpitaux de Paris, Centre de Référence Maladies Rares de la Surrénale, Service d'Endocrinologie, Hôpital Cochin, Paris, France.
Nienke R. Biermasz, Leiden University Medical Center and European Reference Center for Rare Endocrine Conditions (Endo-ERN), Leiden, Netherlands.
Cesar L. Boguszewski, Federal University of Parana, Curitiba, Brazil.
Marcello D. Bronstein, University of Sao Paulo, Sao Paulo, Brazil.
Michael Buchfelder, University Hospital Erlangen, Erlangen, Germany.
John D. Carmichael, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Felipe F. Casanueva, Santiago de Compostela University and Ciber OBN, Santiago de Compostela, Spain.
Frederic Castinetti, Aix Marseille Université, Marseille Medical Genetics, INSERM, Marseille, France; Assistance Publique Hopitaux de Marseille, Marseille, France; Department of Endocrinology, La Conception Hospital, Marseille, France.
Philippe Chanson, Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin-Bicêtre, France.
James Findling, Medical College of Wisconsin, Milwaukee, WI, USA.
Mônica Gadelha, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Eliza B. Geer, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Andrea Giustina, San Raffaele Vita-Salute University, Milan, Italy.
Ashley Grossman, University of London, London, UK; University of Oxford, Oxford, UK.
Mark Gurnell, University of Cambridge, Cambridge, UK; NIHR Cambridge Biomedical Research Center, Cambridge, UK; Addenbrooke's Hospital, Cambridge, UK.
Ken Ho, The Garvan Institute of Medical Research, Sydney, NSW, Australia.
Adriana G. Ioachimescu, Emory University School of Medicine, Atlanta, GA, USA.
Ursula B. Kaiser, Brigham & Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
Niki Karavitaki, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK; Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Laurence Katznelson, Stanford University, Stanford, CA, USA.
Daniel F. Kelly, Pacific Neuroscience Institute, Santa Monica, CA, USA.
André Lacroix, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.
Ann McCormack, The Garvan Institute of Medical Research, Sydney, NSW, Australia.
Shlomo Melmed, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Mark Molitch, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Pietro Mortini, San Raffaele Vita-Salute University, Milan, Italy.
Hershel Raff, Advocate Aurora HealthFollow
et al


Advocate Aurora Research Institute, Aurora St. Luke's Medical Center


Cushing's disease requires accurate diagnosis, careful treatment selection, and long-term management to optimise patient outcomes. The Pituitary Society convened a consensus workshop comprising more than 50 academic researchers and clinical experts to discuss the application of recent evidence to clinical practice. In advance of the virtual meeting, data from 2015 to present about screening and diagnosis; surgery, medical, and radiation therapy; and disease-related and treatment-related complications of Cushing's disease summarised in recorded lectures were reviewed by all participants. During the meeting, concise summaries of the recorded lectures were presented, followed by small group breakout discussions. Consensus opinions from each group were collated into a draft document, which was reviewed and approved by all participants. Recommendations regarding use of laboratory tests, imaging, and treatment options are presented, along with algorithms for diagnosis of Cushing's syndrome and management of Cushing's disease. Topics considered most important to address in future research are also identified.

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