1. Know the Symptoms of Hypercortisolism
Hypercortisolism, also known as Cushing's syndrome, results when one's adrenal glands produce too much cortisol. Hypercortisolism can also result when someone takes drugs similar to cortisone for a long time. To diagnose hypercortisolism, doctors will first conduct a physical exam to look for various symptoms of this condition. Some of the common symptoms of hypercortisolism include thin skin, bruising easily, a puffy face, stretch marks on the stomach, thighs and chest, weight gain, irregular menstrual cycles in women and depression. People with hypercortisolism also typically have excess fat in their upper bodies. This fat tends to occur in the stomach and in between the shoulders (known as a "buffalo hump"). Some people with hypercortisolism will also have high blood glucose levels, high blood pressure and osteoporosis.
2. Look for Variations in Cortisol Levels in Blood and Saliva
Cortisol levels in the body typically display variations depending on the time of the day. In people without hypercortisolism, the levels of cortisol in both their blood and saliva decrease during the nighttime hours. However, people with hypercortisolism will not show this time sensitive variation in cortisol levels. To test for this, a doctor can measure the serum cortisol level of a patient's blood during both the day and the night to see if the expected variation occurs. If the doctor finds no variation, he might suspect hypercortisolism. A doctor can also measure the amount of cortisol in a sample of the patient's saliva taken at night. If the cortisol level in the saliva is too high, a doctor may diagnose hypercortisolism.
3. Measure Cortisol in Urine and Use the Dexamethasone Suppression Test
A common part of the diagnosis of hypercortisolism is the measurement of cortisol in the patient's urine. In many cases, a doctor will require that a patient collect their urine at home over a 24-hour period. A laboratory then measures the level of cortisol in the patient's urine sample. A level of 50 to 100 micrograms of cortisol per day can indicate hypercortisolism. In some suspected cases of hypercortisolism, a doctor will also perform a dexamethasone suppression test. In this test, a patient collects their urine for a 24-hour period. The patient then takes the drug dexamethasone every 6 hours for a 4-day period. While taking the dexamethasone, the patient will also perform a 24-hour urine collection every day. In patients without hypercortisolism, taking dexamethasone will cause the patient's urine cortisol levels to drop. However, if a patient has hypercortisolism, the level of cortisol in their urine does not decrease. This particular test can prove very useful in the diagnosis of hypercortisolism.
4. Use Imaging Techniques to Look for Tumors
Finally, a doctor may use imaging techniques such as magnetic resonance imaging (MRI) or computerized tomography (CT) to help diagnose hypercortisolism. Because hypercortisolism can result due to tumors in the pituitary gland or in the adrenal glands, these imaging techniques can help a doctor see if such tumors exist in a patient's body. The presence of tumors combined with other diagnostic tests can help a doctor accurately diagnose hypercortisolism.
