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

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

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.

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 < 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 <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 <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.

Nocturnal high-dose dexamethasone suppression test in the aetiological diagnosis of Cushing's syndrome

1985 ◽  
Vol 109 (2) ◽  
pp. 158-162 ◽  
Author(s):  
O. D. Bruno ◽  
Maria A. Rossi ◽  
Liliana N. Contreras ◽  
R. M. Gómez ◽  
G. Galparsoro ◽  
...  
Keyword(s):  
Cushing’S Syndrome ◽  
Cushing's Syndrome ◽  
Dexamethasone Suppression Test ◽  
High Dose ◽  
Ectopic Acth ◽  
High Dose Dexamethasone ◽  
Power Of The Test ◽  
Suppression Test ◽  
Aetiological Diagnosis ◽  
Dexamethasone Suppression

Abstract. Seventeen patients with well-proven Cushing's syndrome (13 with Cushing's disease, 3 with adrenal tumour and 1 presenting ectopic ACTH syndrome caused by bronchial carcinoid) were investigated by using a single-dose 8 mg dexamethasone nocturnal test. The results obtained were compared with those of the classical 8 mg Liddle's test, metyrapone stimulation, plasma ACTH concentration and with the final diagnosis reached through surgery, pathologic anatomy, and/or clinical and biochemical follow-up of the patients after treatment. The diagnostic efficacy or the predictive power of the test (defined as the ratio between the number of cases in which the diagnosis was correctly predicted and the total number of cases), was at least 82.4% vs 84.6% for the classical 8 mg Liddle's test. This percentage increased to 94.1% when the results of repeated tests on three patients with conflicting data were included. It is concluded that the nocturnal high-dose dexamethasone suppression test is a valuable tool in the aetiological diagnosis of Cushing's syndrome.

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