Clinical Review Lesson of the week

Raised cortisol excretion rate in urine and contamination by topical steroids

BMJ 2001; 322 doi: (Published 10 March 2001) Cite this as: BMJ 2001;322:594
  1. Christopher J G Kelly (, specialist registrara,
  2. Arla Ogilvie, consultantb,
  3. John R Evans, top grade biochemistb,
  4. David Shapiro, principal biochemista,
  5. A Michael Wallace, principal scientistc,
  6. David L Davies, consultanta
  1. a University Departments of Medicine and Biochemistry, Gardiner Institute, Western Infirmary, Glasgow G11 6NT
  2. b Departments of Medicine and Biochemical Medicine, Stracathro Hospital, Brechin, Angus DD9 7QA
  3. c Department of Clinical Biochemistry, MacEwen Building, Glasgow Royal Infirmary, Glasgow G4 0SF
  1. Correspondence to: C Kelly
  • Accepted 17 November 2000

Beware of contamination of urine samples with topical cortisol during screening for Cushing's syndrome

The clinical features of type 2 diabetes (obesity, hypertension, and glycosuria) often overlap with those of Cushing's syndrome, and as impaired glucose tolerance occurs in up to 20% of patients with Cushing's syndrome, its incidence in people with diabetes is higher than among people without diabetes.1 Diagnosis relies on clinical suspicion and abnormal results of biochemical tests. Measurement of the excretion rate of free cortisol in the urine forms the basis of the initial outpatient investigations and should reflect the overall cortisol secretion provided it is measured accurately. We present two cases from diabetic clinics in which patients had raised urinary free cortisol excretion rates as a result of …

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