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Kuang Hung Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

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Bo-Ching Lee Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

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Po-Ting Chen Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

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Kao-Lang Liu Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

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Chin-Chen Chang Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
Department and Graduate Institute of Forensic Medicine, National Taiwan University College of Medicine, Taipei, Taiwan

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Vin-Cent Wu Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

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Yen-Hung Lin Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

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of the included patients received any kind of glucocorticoid medication before testing. Cross-sectional imaging studies Before AVS, all patients underwent imaging examination, including CT or MRI. All images were reviewed and confirmed by two

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Marcus Imamovic Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden

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Nils Bäcklund Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden

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Staffan Lundstedt Department of Medical Biosciences, Umeå University, Umeå, Sweden

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Göran Brattsand Department of Medical Biosciences, Umeå University, Umeå, Sweden

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Elisabeth Aardal Department of Clinical Chemistry and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden

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Tommy Olsson Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden

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Per Dahlqvist Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden

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study start. Exclusion criteria were known pituitary and/or adrenal gland disease; current glucocorticoid therapy (including inhalations, nasal sprays, skin creams, etc.); hypertension or use of antihypertensive drugs; smoking or other tobacco use

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Ramjan Sanas Mohamed Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK

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Biyaser Abuelgasim Imperial College School of Medicine, Department of Biochemistry, Imperial College Healthcare NHS Trust, London, UK

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Sally Barker Imperial College School of Medicine, Department of Biochemistry, Imperial College Healthcare NHS Trust, London, UK

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Hemanth Prabhudev Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK

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Niamh M Martin Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK

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Karim Meeran Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK

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Emma L Williams Department of Biochemistry, Imperial College Healthcare NHS Trust, London, UK

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Sarah Darch Department of Biochemistry, Imperial College Healthcare NHS Trust, London, UK

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Whitlock Matthew Department of Biochemistry, Imperial College Healthcare NHS Trust, London, UK

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Tricia Tan Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK

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Florian Wernig Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK

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Introduction Cushing’s syndrome (CS) is caused by prolonged and inappropriate exposure of tissues to glucocorticoids ( 1 ). Endogenous CS often poses considerable diagnostic challenges. Most guidelines recommend two different tests to screen

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Paola Parra Ramírez Endocrinology & Nutrition Department, La Paz University Hospital, Madrid, Spain

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Patricia Martín Rojas-Marcos Endocrinology & Nutrition Department, La Paz University Hospital, Madrid, Spain

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Miguel Paja Fano Endocrinology & Nutrition Department, Hospital Universitario de Basurto, Bilbao, Spain
Medicine Department, Basque Country University, Bilbao, Spain

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Marga González Boillos Endocrinology & Nutrition Department, Hospital Universitario de Castellón, Castellón, Spain

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Eider Pascual-Corrales Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain

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Ana García-Cano Biochemistry Department, Hospital Universitario Ramón y Cajal, Madrid, Spain

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Jorge Gabriel Ruiz-Sanchez Endocrinology & Nutrition Department, Hospital Fundación Jiménez Díaz, Madrid, Spain

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Almudena Vicente Endocrinology & Nutrition Department, Complejo Universitario de Toledo, Toledo, Spain

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Emilia Gómez-Hoyos Endocrinology & Nutrition Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain

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Rui Ferreira Endocrinology & Nutrition Department, Hospital Universitario de La Princesa, Madrid, Spain

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Iñigo García Sanz General & Digestive Surgery Department, Hospital Universitario de La Princesa, Madrid, Spain

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Mònica Recasens Endocrinology & Nutrition Department, Hospital Josep Trueta, Servei d’Endocrinologia, Girona, Spain

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Begoña Pla Peris Endocrinology & Nutrition Department, Hospital Universitario de Castellón, Castellón, Spain

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Rebeca Barahona San Millan Endocrinology & Nutrition Department, Hospital Josep Trueta, Servei d’Endocrinologia, Girona, Spain

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María José Picón César Endocrinology & Nutrition Department, Complejo Hospitalario Málaga (Hospital Virgen de la Victoria), IBIMA Malaga, Malaga, Spain
CIBEROBN, Madrid, Spain

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Patricia Díaz Guardiola Endocrinology & Nutrition Department, Hospital Universitario Infanta Sofía, Madrid, Spain

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Juan Jesús García González Endocrinology & Nutrition Department, Hospital Universitario Virgen de la Macarena, Sevilla, Spain

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Carolina Perdomo Endocrinology & Nutrition Department, Clínica Universidad de Navarra, Pamplona, Spain

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Laura Manjón Endocrinology & Nutrition Department, Hospital Universitario Central de Asturias, Oviedo, Spain
Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain

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Rogelio García-Centeno Endocrinology & Nutrition Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain

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Juan Carlos Percovich Endocrinology & Nutrition Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain

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Ángel Rebollo Román Endocrinology & Nutrition Department, Hospital Reina Sofía, Córdoba, Spain

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Paola Gracia Gimeno Endocrinology & Nutrition Department, Hospital Royo Villanova, Zaragoza, Spain

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Cristina Robles Lázaro Endocrinology & Nutrition Department, Hospital Universitario de Salamanca, Salamanca, Spain

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Manuel Morales Biochemistry and Molecular Genetics Department-CDB, Hospital Clinic, IDIBAPS, CIBERehd, Barcelona, Spain

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Felicia Hanzu Endocrinology & Nutrition Department, Hospital Clinic, Barcelona, Spain

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Marta Araujo-Castro Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain
University of Alcalá, Madrid, Spain

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) in whom PA (normal plasma aldosterone (PAC)/renin ratio) and glucocorticoid excess (cortisol post-dexamethasone suppression test <1.8 µg/dL) was excluded, were included as control groups. Two control groups were established: one group <65 years old

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Simone Martins de Castro Hospital Materno Infantil Presidente Vargas, Newborn Screening Referral Center, Porto Alegre, RS, Brazil
Department of Analysis, Universidade Federal do Rio Grande do Sul (UFRGS), School of Pharmacy, Porto Alegre, RS, Brazil

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Paloma Wiest Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil

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Poli Mara Spritzer Division of Endocrinology, Department of Physiology, Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil

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Cristiane Kopacek Hospital Materno Infantil Presidente Vargas, Newborn Screening Referral Center, Porto Alegre, RS, Brazil
Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
Department of Pediatrics, Universidade Federal do Rio Grande do Sul (UFRGS), Medical School, Porto Alegre, RS, Brazil

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progesterone to 11-deoxycorticosterone and 17-hydroxyprogesterone (17-OHP) to 11-deoxycortisol, decreasing mineralocorticoid and glucocorticoid levels and increasing progesterone and 17-OHP levels ( 5 , 6 ). Clinically, CAH is divided into classical and

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Irena Kasacka Department of Histology and Cytophysiology, Medical University of Białystok, Białystok, Poland

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Żaneta Piotrowska Department of Histology and Cytophysiology, Medical University of Białystok, Białystok, Poland

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Natalia Domian Department of Histology and Cytophysiology, Medical University of Białystok, Białystok, Poland

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Alicja Lewandowska Department of Histology and Cytophysiology, Medical University of Białystok, Białystok, Poland

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substantial amount of evidence indicates increased catecholamine secretion as well as the abnormal release of mineralocorticoids and glucocorticoids in hypertension ( 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ). There

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Marianna Viukari Endocrinology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland

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Helena Leijon Department of Pathology, University of Helsinki and HUS Diagnostic Center, Helsinki University Hospital, Helsinki, Finland

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Tiina Vesterinen Department of Pathology, University of Helsinki and HUS Diagnostic Center, Helsinki University Hospital, Helsinki, Finland

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Sanni Söderlund Endocrinology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland

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Päivi Hämäläinen Department of Internal Medicine, Tampere University Hospital, Tampere, Finland

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Iina Yliaska Medical Research Center Oulu, Oulu University Hospital and Research Unit of Internal Medicine, University of Oulu, Oulu, Finland

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Päivi Rautiainen Joint Municipal Authority for North Karelia Social and Health Services (Siun Sote), Joensuu, Finland

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Reeta Rintamäki Department of Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland

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Minna Soinio Department of Endocrinology, Turku University Hospital, Turku, Finland

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Ilkka Pörsti Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland

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Pasi I Nevalainen Department of Internal Medicine, Tampere University Hospital, Tampere, Finland

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Niina Matikainen Endocrinology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland

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. ( https://doi.org/10.1530/EJE-10-1070 ) 28 Arlt W Lang K Sitch AJ Dietz AS Rhayem Y Bancos I Feuchtinger A Chortis V Gilligan LC Ludwig P , et al. Steroid metabolome analysis reveals prevalent glucocorticoid excess in primary

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