Personalized Noninvasive Diagnostic Algorithms Based on Urinary Free Cortisol in ACTH-dependant Cushing's Syndrome.

Autor:	Lavoillotte J; Department of Endocrinology, Diabetes and Nutrition, University Hospital of Bordeaux, 33604 Pessac, France., Mohammedi K; Department of Endocrinology, Diabetes and Nutrition, University Hospital of Bordeaux, 33604 Pessac, France.; University of Bordeaux, INSERM, 'Biologie des maladies cardiovasculaires', U1034, F-33600 Pessac, France., Salenave S; Department of Endocrinology, Bicêtre Hospital, F-94275 Le Kremlin-Bicêtre, France., Furnica RM; Department of Endocrinology and Nutrition, UCLouvain Cliniques universitaires Saint Luc, 1200 Brussels, Belgium., Maiter D; Department of Endocrinology and Nutrition, UCLouvain Cliniques universitaires Saint Luc, 1200 Brussels, Belgium., Chanson P; Department of Endocrinology, Bicêtre Hospital, F-94275 Le Kremlin-Bicêtre, France., Young J; Department of Endocrinology, Bicêtre Hospital, F-94275 Le Kremlin-Bicêtre, France., Tabarin A; Department of Endocrinology, Diabetes and Nutrition, University Hospital of Bordeaux, 33604 Pessac, France.
Jazyk:	angličtina
Zdroj:	The Journal of clinical endocrinology and metabolism [J Clin Endocrinol Metab] 2024 Oct 15; Vol. 109 (11), pp. 2882-2891.
DOI:	10.1210/clinem/dgae258
Abstrakt:	Context: Current guidelines for distinguishing Cushing's disease (CD) from ectopic ACTH secretion (EAS) are questionable, as they use pituitary magnetic resonance imaging (MRI) as first-line investigation for all patients. CRH testing is no longer available, and they suggest performing inferior petrosal sinus sampling (BIPPS), an invasive and rarely available investigation, in many patients. Objective: To establish noninvasive personalized diagnostic strategies based on the probability of EAS estimated from simple baseline parameters. Design: Retrospective study. Setting: University hospitals. Patients: Two hundred forty-seven CD and 36 EAS patients evaluated between 2001 and 2023 in 2 French hospitals. A single-center cohort of 105 Belgian patients served as external validation. Results: Twenty-four-hour urinary free cortisol (UFC) had the highest area under the receiver operating characteristic curve for discrimination of CD from EAS (.96 [95% confidence interval (CI), .92-.99] in the primary study and .99 [95% CI, .98-1.00] in the validation cohort). The addition of clinical, imaging, and biochemical parameters did not improve EAS prediction over UFC alone, with only BIPPS showing a modest improvement (C-statistic index .99 [95% CI, .97-1.00]). Three groups were defined based on baseline UFC: < 3 (group 1), 3-10 (group 2), and > 10 × the upper limit of normal (group 3), and they were associated with 0%, 6.1%, and 66.7% prevalence of EAS, respectively. Diagnostic approaches performed in our cohort support the use of pituitary MRI alone in group 1, MRI first followed by neck-to-pelvis computed tomography scan (npCT) when negative in group 2, and npCT first followed by pituitary MRI when negative in group 3. When not combined with the CRH test, the desmopressin test has limited diagnostic value. Conclusion: UFC accurately predicts EAS and can serve to define personalized and noninvasive diagnostic algorithms. (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
Databáze:	MEDLINE
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