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Michael Weintraub Profile picture
Michael Weintraub
@MWeintraubMD
Endocrinologist & Clin. Asst. Prof. @NYULangone | @WeillCornell and @Sloan_Kettering endocrine fellow alum. | Thomas Jefferson IM alum. Opinions are my own.
Nov 25, 2022 • 8 tweets • 2 min read
How do we diagnose Cushing's? We have 3 screening tests:

1. 24-hour Urinary Free cortisol
2. dexamethasone suppression test
3. Late night salivary cortisol

Late night salivary cortisol is THE BEST first test for Cushing's. Let's explore why the other two have their problems: When can't we trust the dexamethasone suppression test?
1⃣.changes in Cortisol Binding Globulin (CBG)
⏫ CBG- increased estrogen (pregnancy, oral contraceptives, hormone replacement therapy), SERM
⏬ CBG- cirrhosis, nephrotic syndrome, critical illness