High-dose dexamethasone suppression test is inferior to pituitary dynamic enhanced MRI in the differential diagnosis of ACTH-dependent Cushing’s syndrome
| Autor: | Xue feng Yu, Dan Zhu, Ting Lei, Juan Chen, Delin Ma, Jiaojiao Huang, Yan Yang, Xiaoli Shi, Tingting Du, Xuemin Peng, Kun Dong |
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| Rok vydání: | 2021 |
| Předmět: |
ACTH-dependent Cushing's syndrome
medicine.medical_specialty Hydrocortisone medicine.diagnostic_test business.industry Endocrinology Diabetes and Metabolism Urology Magnetic resonance imaging Adrenocorticotropic hormone medicine.disease Magnetic Resonance Imaging Dexamethasone Diagnosis Differential ACTH Syndrome Ectopic Endocrinology Adrenocorticotropic Hormone Diabetes mellitus Dexamethasone suppression test High dose dexamethasone suppression test medicine Humans Differential diagnosis business Cushing Syndrome Serum cortisol |
| Zdroj: | Endocrine. 75:516-524 |
| ISSN: | 1559-0100 1355-008X |
| DOI: | 10.1007/s12020-021-02891-y |
| Popis: | Purpose The differential diagnosis of adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome remains a challenge in clinical practice. The present study was aimed at assessing the diagnostic performance of pituitary dynamic contrast-enhanced magnetic resonance imaging (dMRI), high-dose dexamethasone suppression test (HDDST), and a combination of both tests for patients with ACTH-dependent Cushing's syndrome. Methods A total of 119 consecutive patients with ACTH-dependent Cushing's syndrome confirmed surgically were enrolled: 101 with proven Cushing's disease and 18 with proven ectopic ACTH syndrome. All patients underwent pituitary dMRI and HDDST. The sensitivity and specificity of pituitary dMRI, HDDST, and a combination of both tests were determined. Results The sensitivity and specificity of pituitary dMRI for diagnosing Cushing's disease were 80.2 and 83.3%, respectively, with a positive predictive value of 96.4%. The sensitivity and specificity of HDDST were 70.3 and 77.8%, respectively, with positive predictive value of 94.7%. A combination of both tests showed that the combined criteria of more than 50% suppression of serum cortisol on HDDST and a positive pituitary dMRI finding yielded a high specificity of 94.4 and sensitivity of 59.4%. The combined criteria of more than 68% suppression on HDDST and/or a positive pituitary dMRI finding yielded a sensitivity of 86.1% and specificity of 83.3%. Conclusions Pituitary dMRI was superior to HDDST in the differential diagnosis of ACTH-dependent Cushing's syndrome. HDDST is recommended in combination with pituitary dMRI to establish a diagnosis process because of the significantly increased specificity with the combination. |
| Databáze: | OpenAIRE |
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