Patient case (clinical description): A 47-year-old man comes to the office due to weight gain and fatigue.  He is not able to lift heavy objects or climb stairs. Family history is positive for DM type 2 and HTN in his father.  Blood pressure is 165/90 mm Hg and pulse is 85/min.  On physical examination, there is symmetric proximal muscle weakness of the upper and lower extremities.  Fasting plasma glucose level is 138 mg/dL and 24-hour urinary cortisol is twice the upper normal limit.  Further evaluation reveals that high-dose, but not low-dose, dexamethasone suppresses serum cortisol levels.  Serum ACTH levels are high-normal. This patient's findings are consistent with endogenous Cushing Syndrome.

Patient's own account: I'm a 47-year-old man. I went to the clinic because I had been gaining weight and had increased fatigue over the past few weeks. I was not able to lift heavy objects or even climb the stairs. My dad was diagnosed with type 2 diabetes and high blood pressure. During the exam, they took my blood pressure, which was 165/90 mm Hg, and my pulse was 85/min. They found out that I have weaknesses in both of my arms and legs. I also did a blood test on an empty stomach, and I had a glucose level of 138 mg/dL, and twice the upper normal limit of cortisol. I had high-normal levels of ACTH. The doctor said I suffer from endogenous Cushing Syndrome.

Clinical trial: Diagnostic Performance of Screening Tests for Cushing s Syndrome

Eligibility criteria:
-  INCLUSION CRITERIA:

        Patients presenting for weight loss treatment at the GWUWMP

        Patients must have at least two of the signs and symptoms in Table 1 of the protocol, in
        addition to weight gain. If abdominal pain, backache and/or headache are present, only one
        of these symptoms can be used in any given patient, so that another feature must be
        present.

        Willing and able to be seen for up to 24 months

        Age 18-75

        EXCLUSION CRITERIA:

        Weight more than 350 pounds, the maximum weight for radiologist examination tables
        necessary for the evaluation of Cushing's Syndrome

        Renal failure, creatinine greater than 2.6, because of possible effects on dexamethasone
        metabolism

        Pregnancy, because it alters interpretation of adrenal function tests

        Current use of oral, inhaled or intranasal glucocorticoids or use within 30 days of study

        Other significant medical disorders that may complicate participation or interpretation of
        the results. For example, a patient with a collagen vascular disorder who has taken
        intermittent high dose glucocorticoids, and might need to do this again, might not be
        offered participation.

        Use of black licorice or chewing tobacco within two weeks of the study or anticipated use
        during the study

        Use of phenytoin, barbiturate, loperamide or opiates within two weeks of the study or
        anticipated chronic use during the study.
No condition on gender to be admitted to the trial.
No healthy subjects accepted to join the trial.
Subject must be at least 18 Years old.
Subject must be at most 100 Years

Eligibility (NLI label): Entailment