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Cushing Syndrome C009

Last amended 
19 November 2019
Current RMA Instruments

Reasonable Hypothesis SOP

43 of 2018

Balance of Probabilities SOP

44 of 2018

Changes from previous Instruments

SOP Bulletin 202

ICD Coding
  • ICD-9-CM Codes: 255.0
  • ICD-10-AM Codes: E24.0, E24.2, E24.3, E24.8, E24.9
Brief description

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
  • Hypercortisolism
Diagnoses not covered by SOP
  • Adrenal insufficiency*
  • Hypopituitarism*

* another SOP applies

Clinical onset

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.

Clinical worsening

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.