Accuracy of Diagnostic Tests for Cushing’s Syndrome: A Systematic Review and Metaanalyses

Elamin, Mohamed B.; Murad, M. Hassan; Mullan, Rebecca J.; Erickson, Dana; Harris, Katherine; Nadeem, Sarah; Ennis, Robert; Erwin, Patricia J.; Montori, Víctor M.

doi:10.1210/jc.2008-0139

Cited by 200 publications

(110 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The lack of a circadian rhythm is a peculiar marker of CS (4), so the LNSC test seems to be the best choice to screen for CS because of its noninvasive, stress-free, easy collection in outpatients (1). There is a marked variation between studies in the performance of the LNSC test, reflecting differences in laboratory assays, sample collection, severity of CS, and control groups (2,5,6,7,8,9,10,11,12,13,14). It is also important to have reference data not only for healthy volunteers but also for a control group of obese, hypertensive, diabetic, and depressed subjects or other clinical features of CS that are common in the general population (3,15).…”

Section: Introductionmentioning

confidence: 99%

Performance of salivary cortisol in the diagnosis of Cushing's syndrome, adrenal incidentaloma, and adrenal insufficiency

Ceccato

Barbot

Zilio

et al. 2013

European Journal of Endocrinology

View full text Add to dashboard Cite

Objective: Salivary cortisol has recently been suggested for studies on the hypothalamic-pituitaryadrenal (HPA) axis. The lack of circadian rhythm is a marker of Cushing's syndrome (CS), and some authors have reported that low salivary cortisol levels may be a marker of adrenal insufficiency. The aim of our study was to define the role of salivary cortisol in specific diagnostic settings of HPA axis disease. Subjects and methods: We analyzed morning salivary cortisol (MSC) and late-night salivary cortisol (LNSC) levels in 406 subjects: 52 patients with Cushing's disease (CD), 13 with ectopic CS, 17 with adrenal CS, 27 with CD in remission (a mean follow-up of 66G39 months), 45 with adrenal incidentaloma, 73 assessed as having CS and then ruled out for endogenous hypercortisolism, 75 with adrenal insufficiency, and 104 healthy subjects. Results: A LNSC value above 5.24 ng/ml differentiated CS patients from controls with high sensitivity (96.3%) and specificity (97.1%); we found higher LNSC levels in ectopic CS patients than in CD patients. We found no difference in MSC and LNSC levels between patients with CD in remission and healthy subjects. Both MSC and LNSC levels were higher in patients with adrenal incidentaloma than in healthy controls. A MSC value below 2.65 ng/ml distinguished patients with adrenal insufficiency from controls with high sensitivity (97.1%) and specificity (93.3%). Conclusions: Salivary cortisol is a useful tool to assess endogenous cortisol excess or adrenal insufficiency and to evaluate stable CD in remission.

show abstract

Section: Introductionmentioning

confidence: 99%

Performance of salivary cortisol in the diagnosis of Cushing's syndrome, adrenal incidentaloma, and adrenal insufficiency

Ceccato

Barbot

Zilio

et al. 2013

European Journal of Endocrinology

View full text Add to dashboard Cite

show abstract

“…The three first-line tests commonly used for CS screening are based on different physiopathological characteristics of the HPA axis (3)(4)(5). They are complementary because none of the tests has proven to be fully capable of distinguishing all cases of CS from pseudo-Cushing states.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, Elamin and cols. conducted a systematic review and meta-analysis to summarize the accuracy of these tests in CS diagnosis (5). UFC, LNSF, and 1 mg-DST showed similarly high accuracy when analyzed by classical statistical methods.…”

Section: Introductionmentioning

confidence: 99%

Clinical judgment to estimate pretest probability in the diagnosis of Cushing's syndrome under a Bayesian perspective

Cipoli

Martinez

Castro

et al. 2012

Arq Bras Endocrinol Metab

View full text Add to dashboard Cite

Objective: To estimate the pretest probability of Cushing's syndrome (CS) diagnosis by a Bayesian approach using intuitive clinical judgment. Materials and methods: Physicians were requested, in seven endocrinology meetings, to answer three questions: "Based on your personal expertise, after obtaining clinical history and physical examination, without using laboratorial tests, what is your probability of diagnosing Cushing's Syndrome?"; "For how long have you been practicing Endocrinology?"; and "Where do you work?" . A Bayesian beta regression, using the WinBugs software was employed. Results: We obtained 294 questionnaires. The mean pretest probability of CS diagnosis was 51.6% (95%CI: 48.7-54.3). The probability was directly related to experience in endocrinology, but not with the place of work. Conclusion: Pretest probability of CS diagnosis was estimated using a Bayesian methodology. Although pretest likelihood can be context-dependent, experience based on years of practice may help the practitioner to diagnosis CS. Arq Bras Endocrinol Metab. 2012;56(9):633-7 Keywords Cushing's syndrome; Bayes theorem; pretest probability RESUMO Objetivo: Estimar a probabilidade pré-teste do diagnóstico de síndrome de Cushing (SC) por meio de julgamento clínico utilizando abordagem Bayesiana. Materiais e métodos: Médicos responderam a três perguntas, em sete congressos de endocrinologia. Após obtenção da história clínica/exame físico, sem exames laboratoriais, apenas com base em sua experiência pessoal, qual a probabilidade de diagnosticar SC?; Há quanto tempo você pratica endocrinologia?; Onde você trabalha? Uma regressão beta Bayesiana, utilizando o software WinBugs, foi empregada. Resultados: Foram obtidos 294 questionários. A estimativa Bayesiana da probabilidade média de diagnosticar SC foi 51,6% (IC 95%: 48,3). Houve relação direta entre probabilidade de diagnosticar SC e experiência da prática endócrina, porém não com o local de trabalho. Conclusão: A probabilidade pré-teste do diagnóstico de SC foi estimada utilizando uma metodologia Bayesiana. Embora a probabilidade pré-teste possa ser dependente do contexto, a experiência de anos de prática pode auxiliar no diagnóstico intuitivo da CS. Arq Bras Endocrinol Metab. 2012;56(9):633-7 Descritores Síndrome de Cushing; teorema de Bayes; probabilidade pré-teste

show abstract

“…The 48-h 'low-dose' cortisol suppression test may be used if the overnight test produces a positive or equivocal result. However, a recent meta-analysis concludes that the performance of the frequently used screening tests for Cushing's syndrome, including the overnight and 'low-dose' 48-h dexamethasone suppression tests, is similar (19,20).…”

Section: Cortisol Suppression Testmentioning

confidence: 99%

Investigation of patients with atypical or severe hyperandrogenaemia including androgen-secreting ovarian teratoma

Dennedy

Smith²,

O’Shea³

et al. 2010

European Journal of Endocrinology

View full text Add to dashboard Cite

Approximately 7% of women of reproductive age manifest polycystic ovary syndrome (PCOS) and !0.5% have other causes of hyperandrogenism including congenital adrenal hyperplasia (CAH), androgen-secreting tumour of an ovary or an adrenal gland, Cushing's syndrome or hyperthecosis. The presence of features atypical of PCOS should prompt more extensive evaluation than that usually undertaken. Features atypical of PCOS include the onset of symptoms outside the decade of 15-25 years, rapid progression of symptoms, the development of virilization and a serum testosterone concentration in excess of twice the upper limit of the reference range. Ethnic background, family history and specific clinical findings, e.g. Cushingoid appearance, may inform a focused investigation. Otherwise, patients should have measurement of 17-hydroxyprogesterone (17-OHP) under basal conditions ideally in the early morning, and if abnormal, they should have measurement of 17-OHP one hour after the administration of synthetic ACTH, 250 mg i.v., to screen for CAH, which is present in w2% of hyperandrogenic patients. The overnight cortisol suppression test employing 1 mg dexamethasone at midnight is a sensitive test for Cushing's syndrome. Coronal tomographic (CT) scanning of the adrenals and transvaginal ultrasonography of the ovaries are the investigations of choice when screening for tumours in these organs. Less frequently required is catheterization and sampling from both adrenal and ovarian veins, which is a technically demanding procedure with potential complications which may provide definitive diagnostic information not available from other investigations. Illustrative case reports highlight some complexities in the investigation of hyperandrogenic patients presenting with features atypical of PCOS and include only the ninth case report of an androgen-secreting ovarian teratoma.

show abstract

Accuracy of Diagnostic Tests for Cushing’s Syndrome: A Systematic Review and Metaanalyses

Abstract: Commonly used tests to diagnose CS appear highly accurate in referral practices with samples enriched with patients with CS. Their performance in usual clinical practice remains unclear.

Cited by 200 publications

References 41 publications

Performance of salivary cortisol in the diagnosis of Cushing's syndrome, adrenal incidentaloma, and adrenal insufficiency

Performance of salivary cortisol in the diagnosis of Cushing's syndrome, adrenal incidentaloma, and adrenal insufficiency

Clinical judgment to estimate pretest probability in the diagnosis of Cushing's syndrome under a Bayesian perspective

Investigation of patients with atypical or severe hyperandrogenaemia including androgen-secreting ovarian teratoma

Contact Info

Product

Resources

About