Make flowchart - Phase 1: Screening Tests Step 1: Perform Initial Screening Overnight dexamethasone suppression test (1 mg at midnight, measure cortisol at 0900 h). OR 24-hour urinary free cortisol collection. OR Check for loss of diurnal variation (compare midnight vs. morning cortisol). Step 2: Evaluate Results Normal: Cortisol suppresses to < 50 nmol/L (or urinary cortisol < 280 nmol/24h). Abnormal: Proceed to Phase 2. Phase 2: Diagnostic Tests Step 1: Low-Dose Dexamethasone Suppression Test (LDDST) Administer 0.5 mg every 6 hours for 48 hours. If cortisol fails to suppress to < 50 nmol/L, Cushing Syndrome is confirmed. Step 2: Measure Plasma ACTH ACTH Suppressed: Adrenal disease/Non-ACTH-dependent Cushing syndrome. ACTH Normal/Raised: ACTH-dependent Cushing syndrome (Pituitary or Ectopic source). Phase 3: Localisation Studies Pathway A: If ACTH is Not Detectable Probable Cause: Adrenal Gland Tumour. Action: Perform CT or MRI of adrenal glands. If no lesion found: Proceed to adrenal vein sampling. Pathway B: If ACTH is Detectable Action: Perform High-dose suppression test (2 mg dexamethasone) or CRH test. Scenario 1: Cortisol Responds/Suppresses Diagnosis: Cushing's Disease (Pituitary cause) is likely. Next Steps: MRI of pituitary; consider bilateral inferior petrosal sinus sampling. Scenario 2: Cortisol Does NOT Respond Diagnosis: Ectopic ACTH secretion is likely (e.g., small cell lung carcinoma). Next Steps: IV contrast CT of chest, abdomen, and pelvis. Further Action: MRI of neck, thorax, and abdomen to locate source.
Cushing Syndrome Flowchart
Presentation · PPTX
| Section | Contents |
|---|---|
| Phase 1 — Screening (teal) | Step 1: three initial screening options → Step 2: diamond decision (cortisol suppressed?) → YES → Normal box / NO → Abnormal → feeds Phase 2 |
| Phase 2 — Diagnostic (amber) | LDDST confirmation → Plasma ACTH diamond → Suppressed (Adrenal disease) vs Normal/Raised (ACTH-dependent) → feeds Phase 3 |
| Phase 3A — Pathway A (purple) | ACTH not detectable → Adrenal tumour → CT/MRI adrenals → diamond: lesion found? → No → Adrenal vein sampling |
| Phase 3B — Pathway B (forest green) | ACTH detectable → High-dose DST / CRH test → diamond: cortisol responds? → YES: Cushing's Disease → MRI pituitary ± IPSS / NO: Ectopic ACTH → CT chest/abdomen/pelvis → MRI neck/thorax/abdomen |
- Dark navy background with colour-coded phase banners
- Rounded rectangles for steps, diamonds for decisions
- Directional arrows with YES/NO labels
- Abbreviation key in the footer bar
It's messy create pdf
Cushing Syndrome Flowchart
PDF Document · PDF
| Column | Content |
|---|---|
| Phase 1 (teal) | Step 1 screening box → Step 2 evaluate → diamond (suppressed?) → Normal ✅ left / Abnormal ❌ right |
| Phase 2 (amber) | LDDST confirmation → Plasma ACTH measurement → diamond (ACTH level?) → Suppressed left / Normal-Raised right |
| Phase 3A (purple) | ACTH not detectable → Adrenal tumour → CT/MRI adrenals → diamond (lesion?) → YES treated / NO → Adrenal vein sampling |
| Phase 3B (green) | ACTH detectable → High-dose DST / CRH → diamond (responds?) → YES: Cushing's Disease → MRI pituitary ± IPSS / NO: Ectopic ACTH → CT chest/abdomen/pelvis → MRI neck/thorax/abdomen |