Cushing's syndrome presenting alongside severe hypercortisolism and an acute life-threatening complication demands immediate clinical action. In this setting, treatment cannot wait for completion of the full diagnostic workup.
This protocol applies to patients with severe hypercortisolism who present with one or more of the following life-threatening conditions:
Severe hypercortisolism in this context is itself a life-threatening condition — immediate management is indicated regardless of whether all diagnostic tests have been completed.
Urgent cortisol reduction is the central objective. Combination steroidogenesis inhibitor therapy is a key strategy in eligible patients, with alternative approaches available for those unable to follow the standard route. Concurrent management of the presenting complication is an essential component of care.
DOI: 10.1210/jc.2015-1818
We recommend urgent treatment (within 24–72 h) of hypercortisolism if life-threatening complications of CS such as infection, pulmonary thromboembolism, cardiovascular complications, and acute psychosis are present.
Severe hypercortisolism may be a life-threatening condition that mandates immediate treatment, regardless of whether all diagnostic tests are completed.
The associated disorder(s) should be addressed as well (eg, anticoagulation, antibiotics).
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