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Some cases may be quite obvious, while in others the diagnosis may be difficult to confirm and the source of ACTH problematic, as many clinical and biochemical tests may overlap with Cushing's disease. Imaging is essential, but needs to be interpreted in the light of both anatomical as well as functional imaging modalities. In this review we summarise some of the main diagnostic problems, and emphasise the multimodal and interdisciplinary nature of the diagnostic pathways.<\/jats:p>","DOI":"10.1111\/jne.13137","type":"journal-article","created":{"date-parts":[[2022,4,12]],"date-time":"2022-04-12T05:10:18Z","timestamp":1649740218000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":42,"title":["Distinguishing Cushing's disease from the ectopic <scp>ACTH<\/scp> syndrome: Needles in a haystack or hiding in plain sight?"],"prefix":"10.1111","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4417-7716","authenticated-orcid":false,"given":"Aimee R.","family":"Hayes","sequence":"first","affiliation":[{"name":"Neuroendocrine Tumour Unit, ENETS Centre of Excellence Royal Free Hospital  London 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