Accuracy of immunoassay and mass spectrometry urinary free cortisol in the diagnosis of Cushing’s syndrome

Aranda, Gloria; Careaga, M; Hanzu, Felicia A.; Patrascioiu, Ioana; Ríos, Patricia; Mora, Mireia; Morales‐Romero, Blai; Jiménez, Wladimiro; Halperín, Irene; Casals, Gregori

doi:10.1007/s11102-016-0730-5

Cited by 23 publications

(23 citation statements)

References 23 publications

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“…Based on data derived from a recent study by Aranda and colleagues ( 22 ), a power calculation was performed on the difference in 24 h UFC deemed relevant to detect (20 nmol/24 h). To detect such a difference (with power 80% and alpha 0.05), a sample size of 54 cCSC patients and 18 healthy controls would suffice.…”

Section: Methodsmentioning

confidence: 99%

Cushing’s Syndrome and Hypothalamic–Pituitary–Adrenal Axis Hyperactivity in Chronic Central Serous Chorioretinopathy

et al. 2018

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ObjectiveCentral serous chorioretinopathy (CSC), a specific form of macular degeneration, has been reported as presenting manifestation of Cushing’s syndrome. Furthermore, CSC has been associated with both exogenous hypercortisolism and endogenous Cushing’s syndrome. It is important to know whether CSC patients should be screened for Cushing’s syndrome. Although hypothalamic-pituitary-adrenal (HPA) axis hyperactivity in CSC has been suggested, no detailed evaluation of the HPA axis has been performed in a large cohort of CSC patients. This study aimed to investigate whether Cushing’s syndrome prevalence is increased among chronic CSC (cCSC) patients and whether detailed endocrinological phenotyping indicates hyperactivity of the HPA axis.DesignCross-sectional study.Patients86 cCSC patients and 24 controls.MeasurementsPrevalence of Cushing’s syndrome, HPA axis activity.ResultsNone of the cCSC patients met the clinical or biochemical criteria of Cushing’s syndrome. However, compared to controls, HPA axis activity was increased in cCSC patients, reflected by higher 24 h urinary free cortisol, and accompanying higher waist circumference and diastolic blood pressure, whereas circadian cortisol rhythm and feedback were not different. Chronic CSC patients did not report more stress or stress-related problems on questionnaires.ConclusionNo case of Cushing’s syndrome was revealed in a large cohort of cCSC patients. Therefore, we advise against screening for Cushing’s syndrome in CSC patients, unless additional clinical features are present. However, our results indicate that cCSC is associated with hyperactivity of the HPA axis, albeit not accompanied with perception of more psychosocial stress.

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Section: Methodsmentioning

confidence: 99%

Cushing’s Syndrome and Hypothalamic–Pituitary–Adrenal Axis Hyperactivity in Chronic Central Serous Chorioretinopathy

et al. 2018

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“…In conclusion, this case highlights that the measurement of LNSC, and perhaps the oDST, is the optimal approach to the diagnosis of Cushing's syndrome (1). A normal urine free cortisol is not useful to rule out Cushing's syndrome because of its poor sensitivity (12). As we have stated on many occasions, if you have never missed the diagnosis of Cushing's syndrome or been humbled by trying to establish its cause, you should refer your patients with suspected hypercortisolism to someone who has (2).…”

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confidence: 88%

“…Even in patients with normal renal function, many have questioned the utility of measuring 24-h UFC to diagnose Cushing's disease particularly because of the large number of false negatives (11,12). The measurement of UFC is also questionable considering the likelihood of altered steroid metabolism by severely diseased kidneys (10).…”

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confidence: 99%

A commentary on Diagnosing Cushing’s disease in the context of renal failure

Raff

Cohen

Findling

2019

European Journal of Endocrinology

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The diagnosis of endogenous hypercortisolism (Cushing's syndrome) is extremely challenging. Chronic kidney disease (CKD) increases the activity of the hypothalamic-pituitary-adrenal axis making the diagnosis of Cushing's syndrome even more challenging. This is particularly so since urine free cortisol (UFC) testing is not useful in CKD. The case report by Stroud et al. in this issue of the European Journal of Endocrinology highlights this problem by finding normal UFC in a patient with pituitary ACTH-dependent Cushing's syndrome. Elevated late-night salivary cortisol (LNSC) testing was diagnostic and pituitary adenomectomy was curative. LNSC measurement is the diagnostic test of choice in patients with suspected Cushing's syndrome, particularly in the presence of CKD..

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“…Urinary cortisol— Urinary cortisol testing relies on urine collection over 24 hours to measure the cumulative cortisol produced in that time. Although the diagnostic sensitivity and specificity vary between studies, an elevated 24 hour urinary cortisol level has been found to be 84-93% sensitive and 56-79% specific for diagnosis of Cushing's syndrome 1213…”

Section: What Tests Are Available and How To Interpret Themmentioning

confidence: 99%

Investigating cortisol excess or deficiency: a practical approach

Hanna

Issa

Kevil

et al. 2019

BMJ

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Accuracy of immunoassay and mass spectrometry urinary free cortisol in the diagnosis of Cushing’s syndrome

Abstract: According to our data, both methods present a very similar diagnostic value. However, results suggest that lower cutoff points for mass spectrometry may be necessary in order to improve clinical sensitivity.

Cited by 23 publications

References 23 publications

Cushing’s Syndrome and Hypothalamic–Pituitary–Adrenal Axis Hyperactivity in Chronic Central Serous Chorioretinopathy

Cushing’s Syndrome and Hypothalamic–Pituitary–Adrenal Axis Hyperactivity in Chronic Central Serous Chorioretinopathy

A commentary on Diagnosing Cushing’s disease in the context of renal failure

Investigating cortisol excess or deficiency: a practical approach

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