Endocrine Abstracts

There is limited evidence for the role of screening for Cushing’s syndrome (CS). Patients referred to the specialist medical weight management service at Musgrove Park Hospital have routinely been screened for CS with either an overnight dexamethasone suppression test (ODST) or two 24hour urinary free cortisol (UFC) if evidence of dysglycaemia. We retrospectively analysed the results of all patients referred to the service between 2013–2016. 794 patients were seen as initial assessments, of which 534 had screening tests and were included in the analysis. The mean age was 46±12.4 years, BMI 46.6±7.8 kg/m², weight 132.4±26.7 kg and 72% female. 176 patients were classified as having dysglycaemia. A 9 am cortisol of <50 nmol/L following 1mg of dexamethasone was considered normal. Two or more abnormal UFC collections was considered abnormal. 361 patients underwent ODST, with 350 of those having a normal result. 173 patients underwent UFC, with 162 patients having normal results. Of the abnormal ODST, 8 patients went on to have normal UFC. In 3 patients, a clinical decision was made that the patient did not appear Cushingoid and the test was likely incorrectly done. Of the abnormal UFC, 5 patients went on to have ODST, 2 had further UFC collections and 2 had a Yankowski test all of which were normal. 2 were not thought to be Cushingoid clinically and plan to repeat in due course once diabetes better controlled. No patients were diagnosed with CS in this cohort. This study does not support the routine screening of obese patients referred to a specialised tier 3 weight management service for CS. The average BMI of patients with CS in the European Registry on Cushing’s syndrome was 28±9 kg/m² and so patients with CS may not reach the BMI typically seen in patients referred to a specialist weight management service.