Examination to be performed after admission: Tang Development, Department of Urology, Affiliated Hospital of Guizhou Medical University
Routine examination.
Blood routine, urine routine, stool routine + occult blood, liver and kidney lipid profile, PT+A, seven items of infection
blood group, Rh factor, RPR, calculation of BMI.
Qualitative tests.
1. Combined dose dexamethasone suppression test (6 day method) – fill in the test on the laboratory sheet
2. “24h urine”, followed by “Combined dose dexamethasone suppression test”.
3. Please fill in “UFC” and make sure to mark the day of urine, such as “control day 1” and “control day 2”.
4. “control day 2”, “low dose day 2” or “high dose day 2”, etc.
Day 1
Day 2
Day 3
Day 4
Day 5
Day 6
Control Day 1
Control day 2
Day 1 of low dose
Day 2 of low dose
High dose day 1
High dose day 2
Urine retention for 24hUFC
√
√
×
√
×
√ √
Taking dexamethasone
×
×
√
Dex 0.5mg Q6h
√
Dex 0.5mg Q6h
√
Dex 2.0mg Q6h
√
Dex 2.0mg Q6h
2. blood cortisol circadian rhythm: blood F×3 (8am-4pm-0am).
3. Overnight dexamethasone suppression test: blood F×4 (time of blood sampling: 8am→0am, taking
Dexamethasone 1.0mg→8am the next day), each test sheet should be marked “Overnight small dose dexamethasone
Inhibition test”. Note: (1). Overnight dexamethasone suppression test may be chosen not to be performed if the characterization is clear.
(2). Cortisol rhythm can be done together with the overnight dexamethasone suppression test.
Localization tests.
1. a combined large and small dose dexamethasone suppression test of a large dose dexamethasone suppression test (see table above).
2. If qualitatively clear, the classical high-dose dexamethasone suppression test can also be done directly as follows.
Day 1
Day 2
Day 3
Control day
High dose day 1
Day 2 of high dose dosing
Urine retention for 24hUFC
√
×
√
Take dexamethasone
×
√
Dex 2.0mg Q6h
√
Dex 2.0mg Q6h
3. Overnight high-dose dexamethasone suppression test: blood F × 3 (blood time: 8am→0am, dexamethasone intake)
4. 8.0mg→8am the next day), Note: (1) Each test sheet should be marked “Overnight high dose dexamethasone
5. suppression test”; (2) cortisol rhythm can be completed together with overnight high-dose dexamethasone suppression test. 5.
5. 2 to 3 repeat blood ACTH (8am), with the patient kept quiet before the blood is drawn, and a single shot of blood is required.
6. CT flat scan + enhancement of both adrenal glands, with direct appointment if non-ACTH-dependent Cushing’s syndrome is highly suspected
7. CT flat scan + enhancement + 3D reconstruction of both adrenal glands.
6. MRI of the saddle area (plain + enhancement), or direct appointment for MRI of the saddle area (plain + dynamic enhancement) if there is a high suspicion of Cushing’s disease
7. Chest CT (plain scan + enhancement), octreotide imaging, and lung cancer screening test if ectopic ACTH syndrome is suspected.
Other tests for differential diagnosis.
Prone aldosterone test, 24-hour urine Na, K should be left before the prone test, and blood K, Na, should be drawn the next day.
24-hour urine catecholamines.
Complication tests.
24h urine Ca, P, next day blood Ca, P, ALP, PTH, free Ca
24h urine protein quantification
A gong 1 or 2, FSH, LH, E2, T, PRL, etc.
3h OGTT check (blood Glu×5, blood insulin×5)
ECG, UCG, etc.
Ophthalmology consultation to check fundus when hypertension is clear, and visual field when MEN is suspected.
Bone density (DEXA)
Perform whole body bone gamma imaging if bone pain is obvious or there is a history of fracture.
Birenal hemogram + GFR determination (mandatory preoperatively for those with adrenal occupancy)
Exceptional screening for MEN.
If MEN is considered a possibility, the following tests can be performed: PTH, free Ca, blood calcitonin, blood gastrin, and blood glucagon.
Blood sampling from sublithic veins
To identify whether the cause of Cushing’s syndrome is pituitary or non-pituitary in origin, such as ectopic ACTH syndrome.
subclavian venous blood sampling is required.
Procedure.
1. Fasting and water fasting for 8-10 hours before the procedure, prepare the necessary items for the imaging: bandages, saline 500 ml, heparin 500 ml, and heparin 500 ml.
500 ml of 5% dextrose, 1 heparin, 20 ml of lidocaine, syringe for blood sampling, ice jug, patient’s imaging data, and laboratory test sheets.