{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:03:30Z","timestamp":1756425810408,"version":"3.44.0"},"reference-count":20,"publisher":"BMJ","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ Case Reports"],"abstract":"<jats:p>The diagnosis of endogenous Cushing\u2019s syndrome and its aetiology involved documenting the hypercotisolism and then determining whether that hypercortisolism is adrenocorticotropic hormone-dependent (ACTH-dependent) or not. Hence, following the algorithm, an undetected ACTH level points to an adrenal Cushing\u2019s while a detectable or elevated ACTH level points to either a pituitary or ectopic Cushing\u2019s syndrome. The authors present a case of florid adrenal Cushing\u2019s syndrome initially presenting with a normal ACTH level, which led to the investigation for an ACTH-secreting tumour. Adding to the confusion, a MRI done showed an intrasellar focus. Knowledge of how ACTH-dependent (versus ACTH-independent) Cushing\u2019s syndrome manifests clinically, supported by results of repeat laboratory tests, led to the true diagnosis. This case illustrates that a detectable ACTH does not rule out an adrenal Cushing\u2019s syndrome nor does a positive pituitary imaging confirm Cushing\u2019s disease.<\/jats:p>","DOI":"10.1136\/bcr.08.2011.4694","type":"journal-article","created":{"date-parts":[[2011,12,2]],"date-time":"2011-12-02T19:40:52Z","timestamp":1322854852000},"page":"bcr0820114694","source":"Crossref","is-referenced-by-count":0,"title":["Crossing the other side of the algorithm: a challenging case of adrenal Cushing\u2019s syndrome"],"prefix":"10.1136","volume":"2011","author":[{"given":"Imelda Digna Soberano","family":"Antonio","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark Anthony Santiago","family":"Sandoval","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frances Lina","family":"Lantion-Ang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2011,12,1]]},"reference":[{"key":"2025082801313583000_2011.nov28_1.bcr0820114694.1","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1111\/j.1742-1241.1996.tb10010.x","article-title":"Nocturnal 8 mg dexamethasone suppression test: a practical and accurate test for identification of the cause of endogenous Cushing\u2019s syndrome.","volume":"50","author":"Sriussadaporn","year":"1996","journal-title":"Br J Clin Pract"},{"key":"2025082801313583000_2011.nov28_1.bcr0820114694.2","unstructured":"Horwich PJ Okon SA Krinsky G . 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