New tools for the diagnosis of hypercortisolism.

Diagnosing endogenous autonomous hypercortisolism, spanning from autonomous cortisol secretion to overt Cushing syndrome, remains challenging because of the heterogeneous clinical presentation and the variability of cortisol secretion patterns. Emerging biochemical tools aim to refine and support this diagnostic process. In this review, we examine approaches to enhance classical tests, including measurement of dexamethasone concentrations during the dexamethasone suppression test, as well as newer biomarkers such as salivary cortisone, hair cortisol, metabolomic signatures in plasma and urine, and other omics-based techniques for the detection of hypercortisolism.