en Endocrinology Endocrinology Original Research Original Research <p dir="ltr" style="text-align: justify;"><strong>Background: </strong>Cushing&#39s disease is the most prevalent cause of endogenous adrenocorticotrophic hormone hypersecretion. The aim of this study was to document the current clinical practice pattern in the management of Cushing&#39s disease by Iranian Endocrinologists to determine their opinions and compare them with the current clinical practice guidelines.&nbsp;</p> <p dir="ltr" style="text-align: justify;"><strong>&nbsp; Methods</strong>: An eight-item questionnaire dealing with diagnosis, treatment and follow up of patients with Cushing&#39s disease was developed, piloted, and sent to the members of Iranian Endocrinology Society.</p> <p dir="ltr" style="text-align: justify;"><strong>&nbsp; Results</strong>: Among 90 endocrinologists invited to participate in the survey, 76 replied. Most respondents selected overnight dexamethasone suppression test (ONDST) and assessment of 24-hour urinary free cortisol (UFC) as the best screening tests followed by midnight serum cortisol and midnight salivary cortisol. Classic high dose dexamethasone suppression test and measurement of serum ACTH were selected for localization of the primary lesion by 64.5%. The primary choice of treatment was trans-sphenoidal pituitary surgery (86.8%). For the recurrence of Cushing&#39s disease, the preferred treatment modality was medical therapy followed by bilateral adrenalectomy, and pituitary re-surgery. In case of treatment failure after the first pituitary surgery and ketoconazole treatment, 51% chose bilateral adrenalectomy, while36.8% selected pasireotide only.</p> <p dir="ltr" style="text-align: justify;"><strong>&nbsp; Conclusion</strong>: ONDST and UFC are two most common tests used to screen an index case with signs and symptoms of hypercortisolism. The primary choice of treatment in Cushing&#39s disease is pituitary surgery. However, medical treatment by ketokonazol is preferred for the recurrences. Pasireotide is the second alternative after bilateral adrenalectomy in case of treatment failure after pituitary surgery and ketoconazole.</p> Cushing\'s disease, Diagnosis, Management, Clinical Practice. 210 216 http://mjiri.iums.ac.ir/browse.php?a_code=A-10-1-966&slc_lang=en&sid=1 Mojtaba Malek malekmoj@yahoo.com 200319475328460021420 200319475328460021420 No Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran. Fatemeh Esfehanian fesfehanian@sina.tums.ac.ir 200319475328460021421 200319475328460021421 No Department of Endocrinology, Imam Khomeini Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Atieh Amouzegar amouzegar@endocrine.ac.ir 200319475328460021422 200319475328460021422 No Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Farzaneh Sarvghadi f.sarvghadi@yahoo.com 200319475328460021423 200319475328460021423 No Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Zohreh Moossavi mosaviz@mums.ac.ir 200319475328460021424 200319475328460021424 No Endocrine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Mohammad R. Mohajeri-Tehrani mrmohajeri@tums.ac.ir 200319475328460021425 200319475328460021425 No Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran. Mohammad E. Khamseh khamseh.m@iums.ac.ir 200319475328460021426 200319475328460021426 Yes Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran. Alireza Amirbaigloo amirbaigloo@razi.tums.ac.ir 200319475328460021427 200319475328460021427 No Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran. Ameneh Ebrahim Valojerdi ebrahimv86@gmail.com 200319475328460021428 200319475328460021428 No Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran.