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Differentiating between Cushing's disease and pseudo-Cushing's syndrome: comparison of four tests.
[cushing syndrome]
To
evaluate
the
diagnostic
performance
of
four
different
tests
in
order
to
differentiate
between
Cushing
's
disease
(
CD
)
and
pseudo-
Cushing
's
syndrome
(
PCS
)
.
In
this
prospective
study
,
a
total
of
73
patients
with
clinical
features
of
hypercortisolism
and
insufficient
suppression
of
serum
cortisol
after
1
 
mg
overnight
dexamethasone
and
/
or
an
elevated
excretion
of
cortisol
in
24
-
h
urine
samples
were
included
.
The
circadian
rhythm
of
serum
cortisol
levels
as
well
as
midnight
serum
cortisol
(
MserC
)
levels
were
assessed
in
all
73
patients
.
Late
-
night
salivary
cortisol
(
LNSC
)
concentrations
were
obtained
in
44
patients
.
The
dexamethasone-
CRH
(
Dex
-
CRH
)
test
was
performed
in
54
patients
.
FIFTY-THREE
PATIENTS
WERE
DIAGNOSED
WITH
CD
AND
SUBSEQUENTLY
TREATED
.
TWENTY
PATIENTS
WERE
CLASSIFIED
AS
HAVING
PSC
.
SERUM
CORTISOL
CIRCADIAN
RHYTHM
:
the
diurnal
rhythmicity
of
cortisol
secretion
was
retained
in
PCS
.
A
cortisol
midnight
:
morning
ratio
of
>
0
.
67
is
highly
suggestive
of
CD
(
positive
predictive
value
(
PPV
)
100
%
and
negative
predictive
value
(
NPV
)
73
%
)
.
MserC
concentration
>
243
 
nmol
/
l
has
a
PPV
of
98
%
in
predicting
true
CD
(
NPV
95
%
)
.
LNSC
level
>
9
.
3
 
nmol
/
l
predicted
CD
in
94
%
of
patients
(
NPV
100
%
)
.
Dex
-
CRH
test
:
after
2
days
of
dexamethasone
suppression
,
a
CRH
-stimulated
cortisol
level
>
87
 
nmol
/
l
(
T
=
15
 
min
)
resulted
in
a
PPV
of
100
%
and
an
NPV
of
90
%
.
The
Dex
-
CRH
test
as
well
as
a
single
measurement
of
cortisol
in
serum
or
saliva
at
late
(
mid-
)
night
demonstrated
high
diagnostic
accuracy
in
differentiating
PCS
from
true
CD
.
Diseases
Validation
Diseases presenting
"hypercortisolism"
symptom
adrenal incidentaloma
aromatase deficiency
cushing syndrome
This symptom has already been validated
