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Cushing Syndrome C009
Current RMA Instruments
43 of 2018
44 of 2018
Changes from previous Instruments
- ICD-9-CM Codes: 255.0
- ICD-10-AM Codes: E24.0, E24.2, E24.3, E24.8, E24.9
Cushing syndrome is an endocrine disorder due to chronic exposure to excess glucocorticoids. Typical features include central obesity with fat pads and “moon” face, hypertension, proximal muscle wasting and weakness, hirsutism, purplish streaks on the skin, easy bruising, osteoporosis and psychological symptoms.
Confirming the diagnosis
Diagnosis may be straightforward in someone taking significant doses of glucocorticoid medication and presenting with the classic clinical features. In other cases, particularly where there is an endogenous (internal) cause and a more subtle clinical presentation, the diagnosis can be difficult and specialist opinion with biochemical testing will be required.
Cushing syndrome is commonly caused by taking glucocorticoid drugs. Stopping or reducing such drugs will generally see the condition resolve. It may thus be a temporary condition. A "N.I.F." or "resolved" diagnosis may be appropriate if Cushing syndrome is no longer present.
The relevant medical specialist is an endocrinologist.
Additional diagnoses covered by SOP
- Cushing’s disease
- Cushing’s syndrome
- Ectopic ACTH syndrome
Diagnoses not covered by SOP
- Adrenal insufficiency*
* another SOP applies
Time of clinical onset will generally be based on when the presenting symptoms first developed. Time of commencement of moderate to high dose glucocorticoid medication will also be a good indicator in many cases, with clinical onset typically following within one to six months after treatment commenced, depending on dose.
The only worsening factor is for inability to obtain appropriate clinical management. In cases where glucocorticoid therapy is the cause, whether such therapy should be ceased or reduced will be a matter for clinical judgement in the particular circumstances of the case.