When should I consider referring a patient with suspected Cushing's syndrome to an endocrinologist for further evaluation?

Consider referring a patient with suspected Cushing's syndrome to an endocrinologist for further evaluation if:

• They have at least one abnormal screening test result for Cushing's syndrome.
• Screening tests are normal but clinical suspicion remains high.
• There is suspicion of a malignant underlying cause, in which case referral should be urgent under a suspected cancer pathway.
• The patient is a child or pregnant woman suspected of having Cushing's syndrome, requiring urgent referral to paediatric endocrinology or obstetrics.
• An adrenal adenoma is incidentally found on imaging done for other reasons.

Urgency of referral depends on the clinical situation, with life-threatening complications (such as sepsis, pulmonary embolism, myocardial infarction, or stroke) requiring urgent admission rather than routine referral.

Long-term follow-up and management should be coordinated with endocrinology to normalise cortisol levels and manage comorbidities.

Offer patient information and arrange follow-up to monitor for complications.

NICE CKS