The evaluation of Cushing's disease begins with a medical history and physical examination.

Physical findings in someone with Cushing's disease may include:

• Generalized swelling
• Hypertension
• Increased body hair or hirsutism
• Muscle wasting
• Muscle weakness
• Skin striae (discolored purple stretch marks)
• Thinning of the skin; the skin becomes more fragile and is more susceptible to injury
• Truncal obesity:
• Obesity that spares the limbs

Tests are required to confirm the diagnosis of Cushing's disease.

Tests that may be used to evaluate Cushing's disease include:

• Kidney profile
• Serum aldosterone level
• Serum cortisol level
• Serum ACTH level
• ACTH suppression test
• Dexamethasone suppression test
• Metyrapone test
• Urine 17 ketosteroids
• Urine 17 hydroxycorticosteroids

Imaging tests that may be used to evaluate the pituitary gland in the brain include:

• CT scanning of the brain
• MRI scan of the brain

Imaging tests that may be used to evaluate the adrenal glands include:

• Radionuclide scanning the adrenal glands:
• To identify adrenal hyperplasia or an adrenal tumor.
• CT scanning of the abdomen and adrenal glands

Less common tests that may be used to evaluate Cushing's disease include:

• Chest x-ray
• CT scanning of the chest