scholarly journals Clinical Characteristics of Endogenous Cushing’s Syndrome at a Medical Center in Southern Taiwan

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Shih-Chen Tung ◽  
Pei-Wen Wang ◽  
Rue-Tsuan Liu ◽  
Jung-Fu Chen ◽  
Ching-Jung Hsieh ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Cushing’S Syndrome ◽  
Plasma Cortisol ◽  
Medical Center ◽  
Cushing's Syndrome ◽  
Dexamethasone Suppression Test ◽  
Adrenocortical Adenoma ◽  
Suppression Test ◽  
Southern Taiwan ◽  
Dexamethasone Suppression

From January 1987 to December 2011, over a total of 25 years, 84 patients with Cushing’s syndrome (CS) were identified at a medical center in southern Taiwan. We observed a higher incidence of ACTH-independent CS (75%) than ACTH-dependent CS (25%). A higher incidence of adrenocortical adenoma (58.3%) than Cushing’s disease (CD, 21.4%) was also found. The sensitivity of the definitive diagnostic tests for CS, including loss of plasma cortisol circadian rhythm, a baseline 24 h urinary free cortisol (UFC) value >80 μg, and overnight and 2-day low-dose dexamethasone suppression test, was between 94.4% and 100%. For the 2-day high-dose dexamethasone suppression test for the differential diagnosis of CD, the sensitivity of 0800 h plasma cortisol and 24 h UFC was 44.4% and 85.7%, respectively. For the differential diagnosis of adrenal CS, the sensitivities of the 0800 h plasma cortisol and 24 h UFC were 95.5% and 88.9%, respectively. In patients with ACTH-independent CS and ACTH-dependent CS, the baseline plasma ACTH levels were all below 29 pg/mL and above 37 pg/mL, respectively. The postsurgical hospitalization stay following retroperitoneoscopic adrenalectomy was shorter than that observed for transabdominal adrenalectomy (4.3 ± 1.6 versus 8.8 ± 3.7 days,P<0.001). It was easy to develop retroperitoneal and peritoneal seeding of adrenocortical carcinoma via laparoscopic adrenalectomy.

scholarly journals An Optimized Pathway for the Differential Diagnosis of ACTH-Dependent Cushing’s Syndrome Based on Low-Dose Dexamethasone Suppression Test

2021 ◽  
Vol 12 ◽  
Author(s):  
Kang Chen ◽  
Shi Chen ◽  
Lin Lu ◽  
Huijuan Zhu ◽  
Xiaobo Zhang ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Cushing’S Syndrome ◽  
Low Dose ◽  
Serum Cortisol ◽  
Cushing's Syndrome ◽  
Dexamethasone Suppression Test ◽  
High Dose ◽  
Free Cortisol ◽  
Suppression Test ◽  
Dexamethasone Suppression

ContextTraditionally, low-dose dexamethasone suppression test (LDDST) was used to confirm the diagnosis of Cushing’s syndrome (CS), and high-dose dexamethasone suppression test (HDDST) was used to differentiate Cushing’s disease (CD) and ectopic adrenocorticotropin (ACTH) syndrome (EAS), but some studies suggested that HDDST might be replaced by LDDST. For the differential diagnosis of CS, dexamethasone suppression test was usually combined with other tests such as bilateral petrosal sinus sampling (BIPSS) and pituitary magnetic resonance imaging, but the optimal pathway to incorporate these tests is still controversial.ObjectivesTo develop an optimized pathway for the differential diagnosis of CD and EAS based on LDDST.Design and SettingSingle-center retrospective study (2011–2019).PatientsTwo hundred sixty-nine CD and 29 EAS patients with pathological diagnosis who underwent consecutive low- and high-dose DST.ResultsFor the differential diagnosis of CD and EAS, the area under curve (AUC) of LDDST using urine free cortisol (0.881) was higher than that using serum cortisol (0.685) (p &lt; 0.001) in head-to-head comparison among a subgroup of 108 CD and 10 EAS. The AUC of LDDST (0.883) was higher than that of HDDST (0.834) among all the included patients. With the cutoff of &lt;26%, the sensitivity and specificity of LDDST were 39.4% and 100%. We designed a new pathway in which BIPSS was only reserved for those patients with unsuppressed LDDST and adenoma &lt;6mm, yielding an overall sensitivity of 97.7% and specificity of 86.7%.ConclusionLDDST had similar value to HDDST in differentiating CD and EAS using the specific cutoff point. The pathway that combined LDDST and BIPSS could differentiate CD and EAS accurately.

scholarly journals Association between posttest dexamethasone and cortisol concentrations in the 1 mg overnight dexamethasone suppression test

2012 ◽  
Vol 1 (2) ◽  
pp. 62-67 ◽  
Author(s):  
Bjørn O Åsvold ◽  
Valdemar Grill ◽  
Ketil Thorstensen ◽  
Marit R Bjørgaas
Keyword(s):  
Cushing’S Syndrome ◽  
Plasma Cortisol ◽  
Polynomial Regression ◽  
Regression Line ◽  
Cushing's Syndrome ◽  
Dexamethasone Suppression Test ◽  
Strong Negative Association ◽  
Suppression Test ◽  
Cortisol Levels ◽  
Dexamethasone Suppression

It has been suggested that comparison of posttest dexamethasone and cortisol concentrations may improve the evaluation of the dexamethasone suppression test (DST) for Cushing's syndrome. In particular, this would be reasonable if posttest cortisol differs by dexamethasone levels within the range that is usually attained in the DST. Using fractional polynomial regression, we therefore studied the association between posttest 0800 h dexamethasone and cortisol levels in 53 subjects without Cushing's syndrome who were tested with the 1 mg overnight DST. Plasma dexamethasone was associated with plasma cortisol (P<0.001), and the regression line suggested a strong negative association related to dexamethasone levels <5 nmol/l. However, among the 94% of subjects with plasma dexamethasone >5.0 nmol/l, there was no association between dexamethasone and cortisol levels (P=0.55). In conclusion, subjects tested with the 1 mg overnight DST usually attain an 0800 h plasma dexamethasone >5 nmol/l, and plasma cortisol does not differ by plasma dexamethasone in these subjects. This suggests that routine comparison of dexamethasone and cortisol levels may not be a useful approach to improve the performance of the 1 mg DST. However, dexamethasone measurements may identify subjects with inadequately low plasma dexamethasone and may therefore be of value when retesting subjects with possibly false-positive DST results.

scholarly journals The high-dose dexamethasone suppression test is inferior to pituitary dynamic enhanced MRI in the differential diagnosis of ACTH-dependent Cushing's syndrome

2021 ◽  
Author(s):  
Xiaoli Shi ◽  
Tingting Du ◽  
Dan Zhu ◽  
Delin Ma ◽  
Kun Dong ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Positive Predictive Value ◽  
Cushing’S Syndrome ◽  
Cushing's Syndrome ◽  
Dexamethasone Suppression Test ◽  
High Dose ◽  
Positive Finding ◽  
High Dose Dexamethasone ◽  
Suppression Test ◽  
Dexamethasone Suppression

Abstract Purpose The differential diagnosis of ACTH-dependent Cushing’s syndrome remains a challenge in clinical practice. The aim of the present study was to assess the diagnostic performance of pituitary dynamic enhanced MRI(dMRI), high-dose dexamethasone suppression test༈HDDST༉and combination of both tests in patients with ACTH-dependent Cushing’s syndrome. Methods 119 consecutive cases with surgery confirmed ACTH-dependent Cushing’s syndrome were enrolled: 101 patients with proven Cushing’s disease and 18 patients with proven ectopic ACTH syndrome. All patients underwent pituitary dMRI and HDDST. The sensitivity and the specificity of pituitary dMRI, HDDST, and combination of both tests were calculated. Results The sensitivity and specificity of the pituitary dMRI for the diagnosis of Cushing’s disease was 80.2% and 83.3% respectively, and the positive predictive value was 96.4%. The sensitivity and specificity of HDDST was 70.3% and 77.8%, and the positive predictive value was 94.7%. Regarding the combination of both tests, the combined criteria of a more than 50% suppression of serum cortisol in HDDST and a positive finding in pituitary dMRI had given a high specificity of 94.4% and a sensitivity of 59.4%. The combined criteria of a greater than 68% suppression in HDDST and/or a positive finding in pituitary dMRI, provide a sensitivity of 86.1% and a specificity of 83.3%. Conclusions Pituitary dMRI was superior to HDDST in the differential diagnosis of ACTH-dependent Cushing’s syndrome. HDDST was recommended to combined with pituitary dMRI in the diagnosis process because of the significantly increased specificity of the combination.

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