Who and how to screen for Cushing's syndrome: the position statement of the Italian Society of Endocrinology

Introduction: This Position Statement presents the recommendations of the Italian Society of Endocrinology (SIE) to identify patients with Cushing's syndrome in specific clinical settings. We set two overarching research questions: 1. Which subjects should be screened ("who" should be screened)? 2. Which is the most appropriate first-line test ("how" to screen) for screening? All suggestions/recommendations are evidence-based and directed at endocrinologists and other physicians who deal with patients who have presumptive Cushing's syndrome. Methods: The recommendations, developed by a SIE committee, were formulated based on eight short-reviews commissioned to experts of the SIE Pituitary and Adrenal Clubs. These short reviews, published in a special issue of the Journal of Endocrinological Investigation, reported a comprehensive review of the literature, and each of them answered the two research questions (who and how to screen for hypercortisolism) in a specific population: (1) patients with type 2 diabetes mellitus or obesity; (2) patients with arterial hypertension; (3) children and adolescents; (4) women with hyperandrogenism and/or menstrual irregularities; (5) patients with osteoporosis and/or fractures; (6) patients with mood disorders; (7) patients with adrenal and pituitary incidentaloma; (8) patients with unusual infections or thrombotic events. Finally, 24 recommendations were formulated, based on the quality of available evidence. Conclusions: The evidence-based Position Statement provides clear and pragmatic advice regarding "who" and "how" to screen for Cushing's syndrome. The suggestions/recommendations are developed for all health care providers, not only endocrinologists, to raise awareness on the diagnosis of Cushing's syndrome.