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Cushing’s syndrome: Why is diagnosis so difficult?
David C. Aron1, 2, 3 
(1)
Division of Clinical and Molecular Endocrinology, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
(2)
VA Health Services Research & Development Quality Enhancement Research Initiative Center for Implementation Practice and Research Support, Louis Stokes Cleveland VAMC, Cleveland, OH, USA
(3)
Louis Stokes Department of Veterans Affairs Medical Center, Education Office 14 (W), 10701 East Blvd., Cleveland, OH 44106, USA
Published online: 9 March 2010
Practicing and perfecting the art of medicine demands recognition that uncertainty permeates all clinical decisions. When delivering clinical care, clinicians face a multiplicity of potential diagnoses, limitations in diagnostic capacity, and “sub-clinical” disease identified by tests rather than by clinical manifestations. In addition, clinicians must recognize the rapid changes in scientific knowledge needed to guide decisions. Cushing’s syndrome is one of several disorders in which there may be considerable difficulty and delay in diagnosis. This article describes a current model of clinical reasoning, some of its challenges, and the application of the principles of clinical epidemiology to meet some of those challenges.
Keywords Cushing’s syndrome - Clinical decision making - Clinical epidemiology
David C. Aron
Email: david.aron@va.gov
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