Figure 2.

Diagnostic workup of Cushing syndrome. Flowchart is based on Lacroix et al (3). The likelihood ratios (LRs) for the first-line screening tests and scalp hair analysis concern pooled data from (47) and findings from (48), respectively. LRs take sensitivity and specificity into account and determine the posttest probability given a certain pretest probability (higher LR⁺ = increasing probability of disease with positive test result; lower LR^- = decreasing probability of disease with negative test result). Abbreviations: CBG, cortisol-binding globulin; LR-, negative likelihood ratio; LR+, positive likelihood ratio.