Approach to the diagnosis and treatment of Cushing's Syndrome: "Real-life experience"

Objective: This study aims to evaluate the approaches of endocrinology specialists working in Turkey to the diagnosis, treatment, and follow-up processes of CS, and to identify variations and areas for improvement by analyzing the consistency of these approaches with current clinical guidelines. Materials and Methods: The study was conducted with the participation of 166 endocrinology specialists working in various institutions across Turkey. A total of 49 questions related to the diagnostic, therapeutic, and follow-up stages of Cushing's Syndrome (CS) were administered to the participants through an online survey. In addition to descriptive statistics such as frequency, percentage, mean, and standard deviation, appropriate statistical tests (Chi-square, Fisher's exact test) were used for data analysis. Results: Participants were generally observed to manage CS in accordance with current clinical guidelines. However, differences in clinical approaches were identified based on factors such as professional experience, type of healthcare institution, and academic seniority. The most commonly used screening method for CS was the 1 mg dexamethasone suppression test, while late-night salivary cortisol was the least frequently utilized. Late-night salivary cortisol testing was available in only 41% (n=68) of laboratories. Transsphenoidal surgery was the most preferred treatment modality for Cushing's disease, while pasireotide was the most frequently used agent in medical therapy. A large proportion of participants reported prescribing anticoagulant therapy in high-risk situations such as immobilization and the perioperative period. Conclusion: The professional and demographic characteristics of endocrinologists working in Turkey were examined in detail, and their clinical practices regarding the diagnosis, treatment, and follow-up of Cushing's Syndrome were comprehensively evaluated. Approaches that were consistent and inconsistent with current guideline recommendations were identified, and the possible reasons for these discrepancies were discussed. The findings are expected to raise awareness regarding CS management in Turkey and to contribute to the shaping of future healthcare policies. Keywords: Cushing's Syndrome, clinical practice, survey study, diagnostic and therapeutic approaches, endocrinologist