Which Medical Specialty Should You Consult for Suspected Cushing's Syndrome? - Internal Medicine

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If you suspect you have Cushing's syndrome, the most appropriate medical specialty to consult is Endocrinology. Endocrinologists specialize in hormone-related disorders, including those affecting the adrenal glands, which are responsible for producing cortisol. Cushing's syndrome is characterized by excessive levels of cortisol in the body, which can result from various causes, including adrenal tumors, pituitary adenomas (Cushing's disease), or ectopic ACTH production.

Given your symptoms—such as moon facies, buffalo hump, significant weight gain, and changes in your menstrual cycle—these are indeed indicative of Cushing's syndrome. The presence of visible microvascular changes on your legs and the recent onset of a red patch on your thigh could also be related to the skin changes often seen in patients with this condition.
It's important to note that while initial tests, such as adrenal hormone levels, may return normal, Cushing's syndrome can sometimes present with false negatives. Therefore, further evaluation is warranted. An endocrinologist can perform a comprehensive assessment, which may include:
1. 24-hour Urinary Free Cortisol Test: This test measures the amount of cortisol excreted in urine over a 24-hour period and can help confirm or rule out Cushing's syndrome.

2. Late-night Salivary Cortisol Test: Cortisol levels typically drop at night. Elevated levels during this time can indicate Cushing's syndrome.

3. Low-dose Dexamethasone Suppression Test: This test assesses how your body responds to dexamethasone, a synthetic glucocorticoid. In healthy individuals, dexamethasone suppresses cortisol production, but this suppression may not occur in those with Cushing's syndrome.

4. Imaging Studies: If Cushing's syndrome is confirmed, imaging studies such as MRI or CT scans may be necessary to identify the source of excess cortisol production, whether it be an adrenal tumor, pituitary adenoma, or ectopic source.

In addition to consulting an endocrinologist, it may also be beneficial to work with a primary care physician who can coordinate your care and help manage any other symptoms or complications that arise from your condition. If you are experiencing psychological symptoms such as mood swings or anxiety, a referral to a mental health professional may also be appropriate.

Lastly, if you have already seen multiple specialists without a clear diagnosis, it might be worth seeking a second opinion from another endocrinologist or a specialized center that focuses on adrenal disorders. They may have more experience with complex cases and can provide a more targeted approach to your symptoms.

In summary, for suspected Cushing's syndrome, you should consult an endocrinologist who can conduct the necessary tests and provide a comprehensive evaluation of your condition. Early diagnosis and treatment are crucial to managing Cushing's syndrome effectively and minimizing its potential complications.