Differentials
Obesity
SIGNS / SYMPTOMS
Usually lack facial plethora, unexplained bruising, proximal muscle weakness, violaceous striae, supraclavicular fullness, and osteoporotic fractures.[19]
INVESTIGATIONS
Normal late-night salivary cortisol, dexamethasone suppression testing, or 24-hour urinary free cortisol.
Metabolic syndrome
SIGNS / SYMPTOMS
Usually lack facial plethora, unexplained bruising, proximal muscle weakness, violaceous striae, supraclavicular fullness, and osteoporotic fractures.[19]
INVESTIGATIONS
Normal late-night salivary cortisol, dexamethasone suppression testing, or 24-hour urinary free cortisol.
Primary aldosteronism
SIGNS / SYMPTOMS
May be considered in patients with hypertension and hypokalaemia to help distinguish from ectopic adrenocorticotrophic hormone syndrome.
Patients with primary aldosteronism usually lack facial plethora, unexplained bruising, violaceous striae, supraclavicular fullness, and osteoporotic fractures.[19]
INVESTIGATIONS
Aldosterone/renin ratio is raised. Late-night salivary cortisol or 24-hour urinary free cortisol are normal.
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