Outcome of CRH stimulation test and overnight 8 mg dexamethasone suppression test in 469 patients with ACTH-dependent Cushing’s syndrome
Please always quote using this URN: urn:nbn:de:bvb:20-opus-289450
- 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 adrenalObjective 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.…
Author: | Mario Detomas, Katrin Ritzel, Isabella Nasi-Kordhishti, Stefan Wolfsberger, Marcus Quinkler, Marco Losa, Viola Tröger, Matthias Kroiss, Martin Fassnacht, Greisa Vila, Jürgen Bernd Honegger, Martin Reincke, Timo Deutschbein |
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URN: | urn:nbn:de:bvb:20-opus-289450 |
Document Type: | Journal article |
Faculties: | Medizinische Fakultät / Medizinische Klinik und Poliklinik I |
Language: | English |
Parent Title (English): | Frontiers in Endocrinology |
ISSN: | 1664-2392 |
Year of Completion: | 2022 |
Volume: | 13 |
Article Number: | 955945 |
Source: | Frontiers in Endocrinology (2022) 13:955945. doi: 10.3389/fendo.2022.955945 |
DOI: | https://doi.org/10.3389/fendo.2022.955945 |
Dewey Decimal Classification: | 6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit |
Tag: | ACTH; CRH stimulation test; Cushing's disease; Cushing’s syndrome; diagnosis; ectopic; endogenous hypercortisolism; high dose dexamethasone suppression test |
Release Date: | 2023/04/19 |
Date of first Publication: | 2022/10/06 |
Open-Access-Publikationsfonds / Förderzeitraum 2022 | |
Licence (German): | CC BY: Creative-Commons-Lizenz: Namensnennung 4.0 International |