The Importance of DHEA-S Levels in Cushing's Syndrome; Is There a Cut-off Value in the Differential Diagnosis?

Autor:	Ciftci S; Department of Endocrinology and Metabolsim, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey., Soyluk O; Department of Endocrinology and Metabolism, Istanbul University, Fatih, Turkey., Selek A; Department of Endocrinology and Metabolism, Kocaeli University, Kocaeli, Turkey., Erol S; Department of Endocrinology and Metabolism, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey., Hekimsoy Z; Endocrinology, Celal Bayar University, Manisa, Turkey., Esen A; Department of Endocrinology and Metabolsim, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey., Dursun H; Department of Endocrinology and Meatbolism, Erciyes University School of Medicine, Kayseri, Turkey., Sahin S; Department of Endocrinology and Metabolism, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey., Oruk G; Department of Endocrinology and Metabolism, Izmir Ataturk Training and Research Hospital, Izmir, Turkey., Mert M; Department of Endocrinology and Metabolsim, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey., Soylu H; Department of Endocrinology and Metabolism, Ondokuz Mayis University, School of Medicine, Samsun, Turkey., Yurekli BS; Department of Endocrinology and Metabolism, Ege University Faculty of Medicine, Izmir, Turkey., Ertorer ME; Department of Endocrinology and Metabolism, Baskent University Faculty of Medicine, Adana, Turkey., Omma T; Department of Endocrinology and Metabolism, Ankara Training and Research Hospital, Ankara, Turkey., Evran M; Department of Endocrinology and Metabolism, Çukurova University Medical Faculty, Adana, Turkey., Adas M; Department of Endocrinology and Metabolism, University of Health Sciences, Okmeydani Training and Research Hospital, Istanbul, Turkey., Tanrikulu S; Department of Endocrinology and Metabolsim, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey., Aydin K; Department of Endocrinology and Metabolism, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey., Pekkolay Z; Department of Endocrinology and Metabolism, Dicle Faculty of Medicine, Diyarbakır, Turkey., Can B; Department of Endocrinology and Metabolism, Istanbul Medeniyet University Faculty of Medicine, İstanbul, Turkey., Karakilic E; Department of Endocrinology and Metabolism, Canakkale Onsekiz Mart University Medical Faculty, Çanakkale, Turkey., Karaca Z; Department of Endocrinology and Meatbolism, Erciyes University School of Medicine, Kayseri, Turkey., Bilen H; Department of Endocrinology and Metabolism, Ataturk University Faculty of Medicine, Ezurum, Turkey., Canturk Z; Department of Endocrinology and Metabolism, Kocaeli University, Kocaeli, Turkey., Cetinarslan B; Department of Endocrinology and Metabolism, Kocaeli University, Kocaeli, Turkey., Kadioglu P; Department of Endocrinology and Metabolism, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey., Yarman S; Department of Endocrinology and Metabolism, Istanbul University, Fatih, Turkey.
Jazyk:	angličtina
Zdroj:	Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme [Horm Metab Res] 2022 Apr; Vol. 54 (4), pp. 232-237. Date of Electronic Publication: 2022 Apr 12.
DOI:	10.1055/a-1783-7901
Abstrakt:	The purpose of this study was to determine possible cut-off levels of basal DHEA-S percentile rank in the differential diagnosis of patients with Cushing's syndrome (CS) with ACTH levels in the gray zone and normal DHEA-S levels. In this retrospective study including 623 pathologically confirmed CS, the DHEA-S percentile rank was calculated in 389 patients with DHEA-S levels within reference interval. The patients were classified as group 1 (n=265 Cushing's disease; CD), group 2 (n=104 adrenal CS) and group 3 (n=20 ectopic ACTH syndrome).ROC-curve analyses were used to calculate the optimal cut-off level of DHEA-S percentile rank in the reference interval in the differential diagnosis of CS, and the effectiveness of this cut-off level in the identification of the accurate etiology of CS was assessed in patients who were in gray zone according to their ACTH levels. The DHEA-S percentile rank in the reference interval were significantly lower in group 2 compared to the other two groups (p<0.001), while group 1 and group 3 had similar levels. The optimal cut-off level of DHEA-S percentile rank in the reference interval providing differential diagnosis between group 1 and group 2 was calculated as 19.5th percentile (80.8% sensitivity, 81.5% specificity) and the level demonstrated the accurate etiology in 100% of CD and 76% of adrenal CS patients who were in the gray zone. This study showed that the cut-off value of DHEA-S level less than 20% of the reference interval could be used for differential diagnosis of CD and adrenal CS with high sensitivity and specificity, and it should be taken into the initial evaluation. Competing Interests: The authors declare that they have no conflict of interest. (Thieme. All rights reserved.)
Databáze:	MEDLINE
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