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Figure 2: Algorithm for investigations in the patients of suspected Cushing syndrome (CS) . CD: Cushing's disease; ONDST: Overnight dexamethasone suppression test; LDDST: 48-hour low dose dexamethasone suppression test; UFC: 24-hour urinary free cortisol; ACTH: Adrenocorticotrophic hormone; BIPSS: Bilateral simultaneous inferior petrosal sinus sampling, IPS/P: Ratio of inferior petrosal sinus to peripheral ACTH level; CRH: Corticotrophic releasing hormone; HDDST: Overnight high dose dexamethasone suppression (8 mg dexamethasone at midnight) followed by serum cortisol at 8 AM. A >50% suppression suggests ACTH dependent CS due to pituitary tumour. It is not routinely employed now due to its lower sensitivity

Figure 2: Algorithm for investigations in the patients of suspected Cushing syndrome (CS) . CD: Cushing's disease; ONDST: Overnight dexamethasone suppression test; LDDST: 48-hour low dose dexamethasone suppression test; UFC: 24-hour urinary free cortisol; ACTH: Adrenocorticotrophic hormone; BIPSS: Bilateral simultaneous inferior petrosal sinus sampling, IPS/P: Ratio of inferior petrosal sinus to peripheral ACTH level; CRH: Corticotrophic releasing hormone; HDDST: Overnight high dose dexamethasone suppression (8 mg dexamethasone at midnight) followed by serum cortisol at 8 AM. A >50% suppression suggests ACTH dependent CS due to pituitary tumour. It is not routinely employed now due to its lower sensitivity