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Diagnostic investigations for suspected hypercortisolism may include: 24-hour urinary free cortisol measurements Late-night salivary cortisol testing Low-dose dexamethasone suppression test Plasma ACTH levels to distinguish ACTH-dependent from ACTH-independent causes Imaging studies (pituitary MRI, adrenal CT) when biochemical testing confirms Cushing's syndrome At least two abnormal screening results are usually sought before proceeding to imaging, and conditions causing pseudo-Cushing's states (such as alcohol misuse or severe depression) should be considered

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