Routine tests: blood, urine, stool + occult blood, liver and kidney lipid profile, PT+A, infection 7, blood group, Rh factor, RPR, BMI calculation. Qualitative tests: Sun Fa, Department of Urology, Affiliated Hospital of Guizhou Medical University 1. Combined dose dexamethasone suppression test (6 days method) – fill in the test items on the laboratory list 2. “24h urine”, after which must be marked “Combined dose dexamethasone suppression test “Please fill in “UFC” and make sure to mark the day of urine after it, such as “control day 1”, 4. “control day 2”, and 4. “Control Day 2”, “Small Dose Day 2” or “Large Dose Day 2”, etc. Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Control day 1 Control day 2 Low dose day 1 Low dose day 2 High dose day 1 High dose day 2 Retained urine for 24hUFC √ √ √ √ √ √ √ √ 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 (blood time: 8am→0am, dexamethasone 1.0mg→8am the next day), each test sheet should be marked “Overnight small dose dexamethasone suppression test”. Dexamethasone inhibition test”. Note: (1). Overnight dexamethasone suppression test can be chosen not to be done if the characterization is clear; (2). Cortisol rhythm can be completed in conjunction with the overnight dexamethasone suppression test. Localization tests: 1. High-dose dexamethasone suppression test in combination with small and large dose dexamethasone suppression test (see table above). 2. 2. If the characterization is clear, the classic high-dose dexamethasone suppression test can also be done directly as follows: Day 1 Day 2 Day 3 Control day High-dose dose Day 1 High-dose dose Day 2 Urine retention for 24hUFC √ × √ Dex 2.0mg Q6h √ Dex 2.0mg Q6h 3. Overnight high-dose dexamethasone suppression test: Blood F x 3 (blood taken at: 8am→0am, dexamethasone 4. 8.0mg→8am the next day), Note: (1) Each lab sheet should be labeled “Overnight high dose dexamethasone 5. suppression test”; (2) Cortisol rhythm can be done together with overnight high dose dexamethasone suppression test. 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 plain + enhancement of both adrenal glands, or direct appointment if non-ACTH-dependent Cushing’s syndrome is highly suspected 7. CT plain + 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 + enhanced), 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: 24-hour urine Ca, P, next day blood Ca, P, ALP, PTH, free Ca, 24h urine protein quantification alpha 1 or 2, FSH, LH, E2, T, PRL, etc., 3-hour OGTT check (blood Glu x 5, blood insulin x 5) ECG, UCG, etc. Ophthalmology consultation for fundus check when hypertension is clear, visual field check when MEN is suspected. Bone density (DEXA) Bone pain or history of fracture, whole body bone gamma imaging. Birenal hemogram + GFR determination (mandatory preoperatively if there is adrenal occupancy). If MEN is considered, the following tests can be performed: PTH, free Ca, blood calcitonin, blood gastrin, blood glucagon. To identify the cause of Cushing’s syndrome as pituitary or non-pituitary in origin, such as ectopic ACTH syndrome, subclavian blood sampling is required. The procedure: 1. fasting and water fasting for 8-10 hours before the procedure, preparing the necessary items for the imaging: bandage, saline 500 ml, 5% dextrose 500 ml, heparin 1, lidocaine 20 ml, syringe for blood sampling, ice jug; patient’s imaging data, lab work