• Diagnosis of Cushing’s syndrome is enigmatic.
• Clinical, biochemical and radiological features may not go hand-in-hand.
• 0800 h cortisol is not employed for establishing hypercortisolism. It is used for documenting adrenal insufficiency.
• Intermediate adrenocorticotropic hormone (ACTH) values should be reconfirmed.
• Pituitary incidentaloma is not uncommon: Bilateral inferior petrosal sinus sampling (BIPSS) is complimentary to MRI.
• Lysine vasopressin can be used as an alternative to human corticotropin-releasing hormone (hCRH) for BIPSS.
• Ga⁶⁸ corticotropin-releasing hormone (CRH) PET/CT represents a novel noninvasive integrated functional and anatomical imaging in patients with ACTH-dependant Cushing’s syndrome.

Urinary free cortisol is the best screening test followed by late-night plasma cortisol.