TY  - JOUR
A1  - Detomas, Mario
A1  - Ritzel, Katrin
A1  - Nasi-Kordhishti, Isabella
A1  - Wolfsberger, Stefan
A1  - Quinkler, Marcus
A1  - Losa, Marco
A1  - Tröger, Viola
A1  - Kroiss, Matthias
A1  - Fassnacht, Martin
A1  - Vila, Greisa
A1  - Honegger, Jürgen Bernd
A1  - Reincke, Martin
A1  - Deutschbein, Timo
T1  - Outcome of CRH stimulation test and overnight 8 mg dexamethasone suppression test in 469 patients with ACTH-dependent Cushing’s syndrome
JF  - Frontiers in Endocrinology
N2  - Objective
To evaluate diagnostic accuracy of the corticotropin-releasing hormone (CRH) stimulation test and the overnight 8 mg dexamethasone suppression test (DST) for the differentiation of Cushing’s disease (CD) and ectopic Cushing’s syndrome (ECS).


Methods
Retrospective study in 6 European centers. Inclusion criteria: patients with a) overt adrenocorticotropin (ACTH)-dependent Cushing’s syndrome at the time of dynamic testing, b) histopathological confirmed tumors and/or c) postoperative biochemical remission and/or adrenal insufficiency. Optimal cut-offs were calculated via receiver operating characteristic (ROC) analysis using CD as reference.


Results
469 patients were analyzed [78% females; median age 43 years (IQR 19)]. CRH test and overnight 8 mg DST were performed in 420 [CD, n=394 (94%); ECS, n=26 (6%)] and 237 patients [228 CD (96%), 9 ECS (4%)]. Both tests were performed in 205 patients (44%). The post-CRH %-increase at 30 minutes of both ACTH (cut-off ≥31%, sensitivity 83%, specificity 85%, AUC 0.81) and cortisol (cut-off ≥12%, sensitivity 82%, specificity 89%, AUC 0.86) discriminated best between CD and ECS. A test duration of >60 minutes did not improve diagnostic performance of the CRH test. The optimal cortisol cut-off for the %-suppression during the 8 mg DST was ≥55% (sensitivity 80%, specificity 78%, AUC 0.75).


Conclusion
The CRH test has equivalent sensitivity but higher specificity than the 8 mg DST and is therefore the test of first choice. The diagnostic outcome of ACTH and cortisol is well comparable, however, sampling beyond 60 minutes post-CRH does not provide diagnostic benefits.
KW  - ACTH
KW  - Cushing's disease
KW  - Cushing’s syndrome
KW  - CRH stimulation test
KW  - diagnosis
KW  - ectopic
KW  - endogenous hypercortisolism
KW  - high dose dexamethasone suppression test
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-289450
SN  - 1664-2392
VL  - 13
ER  -