{ "model": { "rank": 7391, "code": "thing-q219102", "model_id": "vr.tr.cushing-s-syndrome", "name": "Cushing's syndrome", "purpose": "Let an agent explain Cushing s syndrome in general terms, relay causes, signs, diagnosis and treatment approaches from endocrinology and veterinary sources, advise against stopping steroids abruptly and route adrenal crisis signs to emergency services, describe the named forms including animal disease, and distinguish Cushing s syndrome from Cushing s disease specifically, obesity, metabolic syndrome, polycystic ovary syndrome and Addison s disease, without diagnosing individuals.", "family": "Thing Registry", "category": "Cross-cutting context", "status": "research-draft", "kind": "thing", "plane": "XCT", "domain": "XCT.STA", "industry": "", "version": "", "url": "/models/thing/q219102/", "tier": 2, "score": 55, "payload": { "layer": "wikidata", "aliases": [ "Cushing's syndrome in mammals", "pituitary-dependent Cushing's disease", "Cushing's disease", "disease with Cushing syndrome as a major feature" ], "aliasCount": 4, "merged": 4, "knownIn": 55, "facets": null, "markers": [], "lexicalClass": "", "senseRank": null, "alsoRegisteredAs": null, "source": { "dataset": "wikidata", "item": "Q219102", "url": "https://www.wikidata.org/wiki/Q219102", "license": "CC0 1.0" } }, "research": { "vercy": "1.0-draft", "publication": { "status": "research-draft", "adjudicationStatus": "unreviewed", "publishableCanonical": false, "generatedAt": "2026-09-13T23:07:57Z", "providers": [ "Claude" ], "breadth": "written by Claude from model knowledge without web access - no source was read, every claim is a lead to verify", "pass": 2, "wave": 4, "engine": "claude" }, "metaModel": { "id": "THING-Q219102", "registryId": "vr.tr.cushing-s-syndrome", "name": "Cushing's syndrome", "version": "0.2.0-wave.4", "entryKind": "thing", "family": "Thing Registry", "domain": [ "XCT.STA" ], "status": "research-draft" }, "canonicalUrl": "https://ver.cy/models/thing/q219102/", "model": { "registry_id": "vr.tr.cushing-s-syndrome", "name": "Cushing's syndrome", "purpose": "Let an agent explain Cushing s syndrome in general terms, relay causes, signs, diagnosis and treatment approaches from endocrinology and veterinary sources, advise against stopping steroids abruptly and route adrenal crisis signs to emergency services, describe the named forms including animal disease, and distinguish Cushing s syndrome from Cushing s disease specifically, obesity, metabolic syndrome, polycystic ovary syndrome and Addison s disease, without diagnosing individuals.", "definition": "A condition caused by prolonged exposure to high levels of cortisol, most often from glucocorticoid medicines, called exogenous Cushing s syndrome, or from the body s own overproduction, including Cushing s disease, the pituitary-dependent form caused by an ACTH-secreting pituitary tumour and named after Harvey Cushing, who described it in 1932, as well as adrenal tumours and ectopic ACTH production; signs include central weight gain, a rounded face, purple stretch marks, easy bruising, muscle weakness, high blood pressure and diabetes, and similar syndromes occur in other mammals, especially dogs and horses. Diagnosis requires specialist testing, and steroid medicines should not be stopped abruptly without medical advice.", "what_it_is_for": "Not applicable; an endocrine disorder.", "affordances": [ "explain causes and signs", "relay diagnosis and treatment approaches", "describe named forms", "relay steroid safety" ], "distinguishing_features": [ "Cortisol excess", "Exogenous or endogenous", "Characteristic physical signs", "Occurs in animals" ], "appearance": "Signs can include a rounded face, fat pad on the upper back, purple striae and thin skin.", "visual_identification": [ "Syndrome of cortisol excess", "Cushing s syndrome in mammals, pituitary-dependent Cushing s disease, Cushing s disease, disease with Cushing syndrome as a major feature", "Cushing s disease is the pituitary form; obesity lacks cortisol excess; metabolic syndrome is a risk cluster; PCOS is ovarian; Addison s disease is cortisol deficiency" ], "physical_properties": [ { "quantity": "first described", "typical_range": "1932", "unit": "year", "note": "Harvey Cushing" }, { "quantity": "most common cause", "typical_range": "glucocorticoid medicines", "unit": "note", "note": "exogenous" }, { "quantity": "screening tests", "typical_range": "late-night salivary cortisol, 24-hour urine cortisol, dexamethasone suppression test", "unit": "list", "note": "" } ], "families_and_kinds": [ "exogenous Cushing s syndrome", "Cushing s disease", "adrenal Cushing s syndrome", "ectopic ACTH syndrome", "canine and equine Cushing s" ], "related_models": [ { "relation": "is a kind of", "target": "adrenal gland hyperfunction", "why": "in registry terms" }, { "relation": "is named after", "target": "Harvey Cushing", "why": "" }, { "relation": "includes", "target": "Cushing s disease", "why": "" }, { "relation": "is contrasted with", "target": "Addison s disease", "why": "" } ], "identifiers": [], "standards_and_regulation": [ "Endocrine Society Cushing s guidelines", "Veterinary endocrinology guidance" ], "failure_modes_and_hazards": [ "Stopping steroids abruptly", "Diagnosing from appearance", "Missing ectopic tumours" ], "in_scope": [], "out_of_scope": [], "characteristics": [] }, "sources": [], "structure": { "bundles": [ { "id": "understand", "name": "Understand", "description": "What Cushing s syndrome is.", "rationale": "Science.", "layers": [ { "id": "definition", "name": "Definition", "description": "Definition.", "findings": [ { "id": "definition-finding", "name": "Definition", "description": "Definition.", "questions": [ { "text": "Is someone on steroids suddenly collapsing, vomiting or confused, in which case call emergency services, and has anyone stopped long-term steroids abruptly without advice?", "kind": "boundary" }, { "text": "What is Cushing s syndrome, and how does it differ from Cushing s disease, obesity, metabolic syndrome, PCOS and Addison s disease?", "kind": "definition" } ] } ] }, { "id": "forms", "name": "Forms", "description": "Named forms.", "findings": [ { "id": "forms-finding", "name": "Forms", "description": "Forms.", "questions": [ { "text": "What are pituitary-dependent Cushing s disease, Cushing s in mammals and diseases featuring the syndrome?", "kind": "definition" }, { "text": "Which entry fits the specific form?", "kind": "action" } ] } ] } ] }, { "id": "medicine", "name": "Medicine", "description": "Causes and diagnosis.", "rationale": "Science.", "layers": [ { "id": "causes", "name": "Causes", "description": "Causes.", "findings": [ { "id": "causes-finding", "name": "Causes", "description": "Causes.", "questions": [ { "text": "How do medicines, pituitary tumours, adrenal tumours and ectopic ACTH cause cortisol excess?", "kind": "provenance" }, { "text": "Which references are standard?", "kind": "provenance" } ] } ] }, { "id": "tests", "name": "Tests", "description": "Tests.", "findings": [ { "id": "tests-finding", "name": "Tests", "description": "Tests.", "questions": [ { "text": "Which tests do guidelines recommend, in general terms?", "kind": "provenance" }, { "text": "Which sources are cited?", "kind": "provenance" } ] } ] } ] }, { "id": "treatment", "name": "Treatment", "description": "Treatment.", "rationale": "Regulation.", "layers": [ { "id": "surgery", "name": "Surgery", "description": "Surgery.", "findings": [ { "id": "surgery-finding", "name": "Surgery", "description": "Surgery.", "questions": [ { "text": "What surgical and medical treatments are used, in general terms?", "kind": "provenance" }, { "text": "Which entry fits transsphenoidal surgery?", "kind": "action" } ] } ] }, { "id": "steroids", "name": "Steroid tapering", "description": "Steroid tapering.", "findings": [ { "id": "steroids-finding", "name": "Steroid tapering", "description": "Steroid tapering.", "questions": [ { "text": "Why must steroid medicines be tapered under medical supervision?", "kind": "provenance" }, { "text": "Which entry fits corticosteroid?", "kind": "action" } ] } ] } ] }, { "id": "context", "name": "Context", "description": "Animals and history.", "rationale": "Context.", "layers": [ { "id": "animals", "name": "Animals", "description": "Dogs and horses.", "findings": [ { "id": "animals-finding", "name": "Animals", "description": "Animals.", "questions": [ { "text": "How does Cushing s appear in dogs and horses, and when should owners see a vet?", "kind": "provenance" }, { "text": "Which entry fits equine Cushing s disease?", "kind": "action" } ] } ] }, { "id": "cushing", "name": "Harvey Cushing", "description": "Harvey Cushing.", "findings": [ { "id": "cushing-finding", "name": "Harvey Cushing", "description": "Harvey Cushing.", "questions": [ { "text": "Who was Harvey Cushing?", "kind": "provenance" }, { "text": "Which entry fits Harvey Cushing?", "kind": "action" } ] } ] } ] } ] }, "openQuestions": [ "Should animal Cushing s be a separate entry?", "How should endocrinology guidelines be linked?", "Should Cushing s disease be split from the syndrome?" ], "statistics": { "bundles": 4, "layers": 8, "findings": 8, "questions": 16 } }, "draft": { "generator": "vr.draft.v3", "status": "draft-generated", "researched": false, "archetype": "disease or condition", "method": "Written from the archetype playbook - what this kind of thing needs beyond identity and provenance - and from the structure that recurred across 6,333 models already researched by two engines. Applied to this entry by rule. No source was read for this thing and no claim here is researched. This entry carries no facets of its own, so they were inferred from its domain - a guess about a whole domain applied to one thing.", "facetsInferred": true, "nextPass": "A researcher replaces this draft with a sourced specification. Treat every sentence below as a proposal to argue with.", "purpose": "Give an agent a durable, checkable way to recognise a Cushing's syndrome, record what state it is in, and decide what may be done with it.", "whatItIs": "Let an agent explain Cushing s syndrome in general terms, relay causes, signs, diagnosis and treatment approaches from endocrinology and veterinary sources, advise against stopping steroids abruptly and route adrenal crisis signs to emergency services, describe the named forms including animal disease, and distinguish Cushing s syndrome from Cushing s disease specifically, obesity, metabolic syndrome, polycystic ovary syndrome and Addison s disease, without diagnosing individuals.", "characteristics": { "substance": "abstract", "origin": "conceptual", "agency": "inert" }, "whatYouCanDoWithIt": [ "observed and measured" ], "distinguishingFeatures": [ "Names folded into this entry, which a task may need to split apart again: Cushing's syndrome in mammals, pituitary-dependent Cushing's disease, Cushing's disease, disease with Cushing syndrome as a major feature.", "4 finer distinctions are held as aliases rather than separate entries, because telling them apart needs a task that asks for it.", "Described in 55 Wikipedia languages, which is a measure of how widely the thing is known, not of how important it is." ], "openQuestionsForResearch": [ "Which of the bundles below does a real task actually need, and which are ceremony?", "What does this thing have that the facets do not capture at all?", "Which neighbouring kind is most often confused with a Cushing's syndrome, and on what evidence are they told apart?" ], "whatItIsMadeOf": "an abstraction with no physical instance", "physicalCharacter": [ "Does nothing on its own; everything it does, something else did to it.", "These come from the domain this entry sits in rather than from the entry itself, so treat them as a first guess about the whole domain applied to one thing." ], "whatCanBeDoneWithIt": [ "observe it, measure it, record its state" ], "howItIsRecognised": [ "Recognised by criteria applied to signs and findings, not by appearance. Two conditions can look identical and be distinguished only by test." ], "relatedModels": [ { "relation": "covers", "note": "Finer kinds folded into this entry because telling them apart needs a task that asks for it. Each is a model waiting to be split out when one does.", "targets": [ "Cushing's syndrome in mammals", "pituitary-dependent Cushing's disease", "Cushing's disease", "disease with Cushing syndrome as a major feature" ] } ], "standing": "Described in 55 Wikipedia languages, which measures how widely it is written about rather than how important or how common it is. 4 finer distinctions are held inside this entry as names rather than as separate models.", "structure": { "bundles": [ { "id": "identity-and-classification", "name": "Identity, naming and classification", "description": "How an agent tells one Cushing's syndrome from another, and a Cushing's syndrome from things that resemble it.", "rationale": "Recognition comes before every other claim. Without stable identity nothing else in the model can be trusted to be about the same thing twice.", "layers": [ { "id": "naming-and-identifiers", "name": "Names and identifiers", "description": "The names this thing goes by and the identifiers that survive translation and time.", "findings": [ { "id": "preferred-name-and-aliases", "name": "Preferred name, aliases and local names", "description": "Which name to use, which names mean the same thing, and which merely sound similar.", "questions": [ { "id": "preferred-name-and-aliases-q01", "text": "What identifies and describes the name of a Cushing's syndrome, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "preferred-name-and-aliases-q02", "text": "Who or what asserted this about the name of a Cushing's syndrome, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "preferred-name-and-aliases-q03", "text": "What may an agent decide or do once the name of a Cushing's syndrome is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] }, { "id": "stable-identifiers", "name": "Stable identifiers and external keys", "description": "Identifiers that keep pointing at this kind of thing across systems and languages.", "questions": [ { "id": "stable-identifiers-q01", "text": "What identifies and describes an identifier for a Cushing's syndrome, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "stable-identifiers-q02", "text": "Who or what asserted this about an identifier for a Cushing's syndrome, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "stable-identifiers-q03", "text": "What may an agent decide or do once an identifier for a Cushing's syndrome is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] }, { "id": "classification-and-granularity", "name": "Classification and granularity", "description": "Where a Cushing's syndrome sits among kinds, and how finely a task needs to cut it.", "findings": [ { "id": "kind-and-parents", "name": "Kind, parents and neighbouring kinds", "description": "The classes this thing belongs to and the ones it is next to.", "questions": [ { "id": "kind-and-parents-q01", "text": "What identifies and describes the kind of a Cushing's syndrome, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "kind-and-parents-q02", "text": "Who or what asserted this about the kind of a Cushing's syndrome, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "kind-and-parents-q03", "text": "What may an agent decide or do once the kind of a Cushing's syndrome is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] }, { "id": "distinguishing-features", "name": "Distinguishing features", "description": "What separates a Cushing's syndrome from the things most often confused with it.", "questions": [ { "id": "distinguishing-features-q01", "text": "What identifies and describes what distinguishes a Cushing's syndrome, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "distinguishing-features-q02", "text": "Who or what asserted this about what distinguishes a Cushing's syndrome, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "distinguishing-features-q03", "text": "What may an agent decide or do once what distinguishes a Cushing's syndrome is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] } ] }, { "id": "state-and-lifecycle", "name": "State and lifecycle", "description": "The states a Cushing's syndrome passes through and the events that move it between them.", "rationale": "Most decisions about a thing depend on what state it is in now, which is a claim with a time on it, not a property.", "layers": [ { "id": "lifecycle-stages", "name": "Lifecycle stages", "description": "From coming into existence to ceasing to be one of these.", "findings": [ { "id": "stages-and-transitions", "name": "Stages and transitions", "description": "The stages worth naming and what moves a Cushing's syndrome between them.", "questions": [ { "id": "stages-and-transitions-q01", "text": "What identifies and describes the lifecycle of a Cushing's syndrome, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "stages-and-transitions-q02", "text": "Who or what asserted this about the lifecycle of a Cushing's syndrome, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "stages-and-transitions-q03", "text": "What may an agent decide or do once the lifecycle of a Cushing's syndrome is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] }, { "id": "observations-and-status", "name": "Observations and current status", "description": "What is observed about a Cushing's syndrome, how often and by whom.", "findings": [ { "id": "observation-record", "name": "Observation record", "description": "How an observation of a Cushing's syndrome is recorded so that it can be superseded rather than overwritten.", "questions": [ { "id": "observation-record-q01", "text": "What identifies and describes an observation of a Cushing's syndrome, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "observation-record-q02", "text": "Who or what asserted this about an observation of a Cushing's syndrome, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "observation-record-q03", "text": "What may an agent decide or do once an observation of a Cushing's syndrome is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] } ] }, { "id": "diagnosis-and-criteria", "name": "Diagnosis, criteria and coding", "description": "What makes a case of Cushing's syndrome a case, and under which revision.", "rationale": "Criteria change between revisions, so a diagnosis without its coding revision cannot be compared with a later one.", "layers": [ { "id": "criteria", "name": "Diagnostic criteria", "description": "The criteria in force and who issues them.", "findings": [ { "id": "criteria-record", "name": "Criteria, issuer and revision", "description": "What must be true for a diagnosis, according to whom.", "questions": [ { "id": "criteria-record-q01", "text": "What criteria define Cushing's syndrome, issued by which body, in which revision?", "kind": "definition" }, { "id": "criteria-record-q02", "text": "What changed between revisions that would reclassify existing cases?", "kind": "boundary" } ] } ] }, { "id": "coding", "name": "Coding and terminology", "description": "The codes used to record it and their mapping.", "findings": [ { "id": "coding-record", "name": "Codes and mappings", "description": "Which classification codes apply and how they map.", "questions": [ { "id": "coding-record-q01", "text": "Which classification and terminology codes cover Cushing's syndrome, and how do they map to each other?", "kind": "definition" }, { "id": "coding-record-q02", "text": "What is lost when a case is mapped from one scheme to another?", "kind": "boundary" } ] } ] } ] }, { "id": "course-and-population", "name": "Course, population and care", "description": "How Cushing's syndrome develops, whom it affects, and what is done about it.", "rationale": "The condition, the diagnosis and the episode of care are three different things, and an agent must not merge them.", "layers": [ { "id": "course", "name": "Course and stages", "description": "Onset, progression, remission and outcome.", "findings": [ { "id": "course-record", "name": "Stages and transitions", "description": "The stages recorded and what moves a case between them.", "questions": [ { "id": "course-record-q01", "text": "What course does Cushing's syndrome typically take, and what marks each stage?", "kind": "definition" }, { "id": "course-record-q02", "text": "What separates the condition itself from an episode of care for it?", "kind": "boundary" } ] } ] }, { "id": "population", "name": "Affected populations", "description": "Who is affected, how often, and on what evidence.", "findings": [ { "id": "epidemiology", "name": "Prevalence and its basis", "description": "Rates with their population, period and source.", "questions": [ { "id": "epidemiology-q01", "text": "What prevalence or incidence is reported for Cushing's syndrome, in which population and period?", "kind": "measurement" }, { "id": "epidemiology-q02", "text": "What may an agent not conclude about an individual from a population rate?", "kind": "action" } ] } ] } ] }, { "id": "provenance-and-evidence", "name": "Provenance, evidence and time", "description": "Where every claim about a Cushing's syndrome came from and when it held.", "rationale": "A claim without a source and a time cannot be superseded, only overwritten, and an agent that overwrites loses the ability to explain itself.", "layers": [ { "id": "source-and-authority", "name": "Source and authority", "description": "Who said it, on what evidence, and how strongly.", "findings": [ { "id": "claim-provenance", "name": "Claim provenance and confidence", "description": "The authority behind each claim about a Cushing's syndrome and how confident it is.", "questions": [ { "id": "claim-provenance-q01", "text": "What identifies and describes a claim about a Cushing's syndrome, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "claim-provenance-q02", "text": "Who or what asserted this about a claim about a Cushing's syndrome, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "claim-provenance-q03", "text": "What may an agent decide or do once a claim about a Cushing's syndrome is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] }, { "id": "time-and-versions", "name": "Time, versions and supersession", "description": "When a claim was true, when it was learnt, and what replaced it.", "findings": [ { "id": "validity-and-supersession", "name": "Validity period and supersession", "description": "How an old claim about a Cushing's syndrome is retired without being erased.", "questions": [ { "id": "validity-and-supersession-q01", "text": "What identifies and describes the validity of a claim about a Cushing's syndrome, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "validity-and-supersession-q02", "text": "Who or what asserted this about the validity of a claim about a Cushing's syndrome, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "validity-and-supersession-q03", "text": "What may an agent decide or do once the validity of a claim about a Cushing's syndrome is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] } ] } ] }, "statistics": { "bundles": 5, "layers": 10, "findings": 12, "questions": 32 } } } }