Second-line tests in the differential diagnosis of ACTH-dependent Cushing’s syndrome

Autor: Rodica Mardari, Nora Albiger, Laura Trementino, Anna Chiara Frigo, Giorgio Arnaldi, Giuseppe Rolma, Mattia Barbot, Filippo Ceccato, Carla Scaroni, Marialuisa Zilio, Andrea Daniele, Marco Boscaro
Rok vydání: 2016
Předmět:
Adult
Male
Desmopressin test
endocrine system
medicine.medical_specialty
ACTH-dependent Cushing's syndrome
Adolescent
Corticotropin-Releasing Hormone
Ectopic Cushing’s syndrome
Endocrinology
Diabetes and Metabolism
Urinary system
Neuroimaging
030209 endocrinology & metabolism
Dexamethasone
Diagnostic Techniques
Endocrine
Young Adult
03 medical and health sciences
Basal (phylogenetics)
0302 clinical medicine
Endocrinology
Internal medicine
CRH test
medicine
Humans
Deamino Arginine Vasopressin
Desmopressin
Cushing Syndrome
Aged
Retrospective Studies
Dexamethasone test
business.industry
Cushing's disease
Middle Aged
Cushing’s disease
medicine.disease
Diabetes and Metabolism
Cushing’s syndrome
030220 oncology & carcinogenesis
Female
MRI
Differential diagnosis
business
hormones
hormone substitutes
and hormone antagonists
medicine.drug
Hormone
Zdroj: Pituitary. 19:488-495
ISSN: 1573-7403
1386-341X
DOI: 10.1007/s11102-016-0729-y
Popis: Diagnosing Cushing's syndrome (CS) can be a challenge, especially in ACTH-dependent CS, when it comes to detecting the origin of ACTH secretion.Retrospective data were collected on 170 patients with ACTH-dependent CS (149 CD, 21 EAS) referring to two endocrinology units, focusing on three non-invasive tests: dexamethasone 8 mg overnight challenge (HDDST); corticotrophin-releasing hormone (CRH) assay and the desmopressin (DDAVP) test.Patients with EAS were slightly older and had higher ACTH, serum and urinary cortisol levels than patients with CD (p 0.01). CD patients had a stronger ACTH and cortisol response after CRH injection (p 0.0001), and a more pronounced reduction in cortisol levels after HDDST (p 0.0001). A threshold percentage ACTH increase after CRH stimulation of 72.4 % was able to identify CD with a sensitivity (SE) of 76 % (95 % CI 68-83) and a specificity (SP) of 100 % (95 % CI 83-100). As for HDDST, a cortisol suppression52.7 % below the basal level suggested a pituitary origin with a SE of 88 % (95 % CI 81-93) and a SP of 90 % (95 % CI 68-99). There were no cases of EAS with positive responses to both these tests. Increases in ACTH and cortisol levels after the DDAVP test were also higher in CD than in EAS (p 0.01), though the SE and SP were lower.Patients with CD showed a stronger response to HDDST and CRH, and the adopted cut-offs showed a good SE and SP in discriminating them from patients with EAS. Concordant tests indicated CD when positive, whereas no response to either test was highly suggestive of EAS. The DDAVP test was of limited utility in the diagnostic phase. In conclusion, the choice of tests may play an important part in the differential diagnosis of ACTH-dependent CS.
Databáze: OpenAIRE
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