Troughs

CCS (Cyclic Cushing Syndrome), DST (Desmopressin Stimulation Test), ACTH (Adrenocorticotropic Hormone), Inferior Petrosal Sinus Sampling (BIPSS). Cushing's Syndrome (CS). Continuous Glucose Monitoring (CGM). Dexamethasone Suppression Test (DST), Late-Night Salivary Cortisol (LNSC) Cyclic Cushing’s syndrome (CCS) represents a variant of Cushing’s syndrome characterized by alternating episodes of elevated cortisol levels (peaks) and spontaneous intervals of normal or reduced cortisol secretions (troughs) (1). The widely accepted definitions of cyclic Cushing's syndrome are based on two main criteria: the first involves three peaks in cortisol levels that indicate hypercortisolemia, interspersed with two troughs reflecting euocortisolaemia. The second criterion consists of two peaks separated by one trough (1). The duration of these phases can fluctuate, lasting anywhere from several days to 86 days or even extending over years. Cyclic Cushing’s syndrome presents significant challenges within the field of modern endocrinology. It is observed more frequently in women, with a male-to-female ratio of 1:3. In comparison to those with Cushing’s syndrome, patients with cyclic Cushing’s syndrome tend to be older, typically between 50 and 60 years of age, and often have a history of alcohol consumption, averaging 1 to 7 drinks per week( 2).