Diagnostic tests for Cushing's syndrome differ from published guidelines: data from ERCUSYN.
|Abstract||To evaluate which tests are performed to diagnose hypercortisolism in patients included in the European Registry on Cushing's syndrome (ERCUSYN), and to examine if their use differs from the current guidelines.|
A comparison of the standard high dose dexamethasone suppression test and the overnight 8-mg dexamethasone suppression test for the differential diagnosis of adrenocorticotropin-dependent Cushing's syndrome.
|Journal Title||european journal of endocrinology|
|Publication Year Start||2017-01-01|
PMID- 28377460 OWN - NLM STAT- MEDLINE DA - 20170405 DCOM- 20170413 LR - 20170418 IS - 1479-683X (Electronic) IS - 0804-4643 (Linking) VI - 176 IP - 5 DP - 2017 May TI - Diagnostic tests for Cushing's syndrome differ from published guidelines: data from ERCUSYN. PG - 613-624 LID - 10.1530/EJE-16-0967 [doi] AB - OBJECTIVE: To evaluate which tests are performed to diagnose hypercortisolism in patients included in the European Registry on Cushing's syndrome (ERCUSYN), and to examine if their use differs from the current guidelines. PATIENTS AND METHODS: We analyzed data on the diagnostic tests performed in 1341 patients with Cushing's syndrome (CS) who have been entered into the ERCUSYN database between January 1, 2000 and January 31, 2016 from 57 centers in 26 European countries. Sixty-seven percent had pituitary-dependent CS (PIT-CS), 24% had adrenal-dependent CS (ADR-CS), 6% had CS from an ectopic source (ECT-CS) and 3% were classified as having CS from other causes (OTH-CS). RESULTS: Of the first-line tests, urinary free cortisol (UFC) test was performed in 78% of patients, overnight 1 mg dexamethasone suppression test (DST) in 60% and late-night salivary cortisol (LSaC) in 25%. Use of LSaC increased in the last five years as compared with previous years (P < 0.01). Use of HDDST was slightly more frequent in the last 5 years as compared with previous years (P < 0.05). Of the additional tests, late-night serum cortisol (LSeC) was measured in 62% and 48-h 2 mg/day low-dose dexamethasone suppression test (LDDST) in 33% of cases. ACTH was performed in 78% of patients. LSeC and overnight 1 mg DST supported the diagnosis of both PIT-CS and ADR-CS more frequently than UFC (P < 0.05). CONCLUSIONS: Use of diagnostic tests for CS varies across Europe and partly differs from the currently available guidelines. It would seem pertinent that a European consensus be established to determine the best diagnostic approach to CS, taking into account specific inter-country differences with regard to the availability of diagnostic tools. CI - (c) 2017 European Society of Endocrinology. FAU - Valassi, Elena AU - Valassi E AD - IIB-Sant Pau and Department of Endocrinology/MedicineHospital Sant Pau, UAB, and Centro de Investigacion Biomedica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, Barcelona, Spain. FAU - Franz, Holger AU - Franz H AD - Lohmann & Birkner Health Care Consulting GmbHBerlin, Germany. FAU - Brue, Thierry AU - Brue T AD - Aix-Marseille UniversiteCNRS, CRN2M UMR 7286, and APHM, Hopital Conception, Marseille, France. FAU - Feelders, Richard A AU - Feelders RA AD - Erasmus University Medical CentreRotterdam, The Netherlands. FAU - Netea-Maier, Romana AU - Netea-Maier R AD - Radboud University Medical CentreNijmegen, The Netherlands. FAU - Tsagarakis, Stylianos AU - Tsagarakis S AD - Athens Polyclinic General HospitalEvangelismos Hospital, Athens, Greece. FAU - Webb, Susan M AU - Webb SM AD - IIB-Sant Pau and Department of Endocrinology/MedicineHospital Sant Pau, UAB, and Centro de Investigacion Biomedica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, Barcelona, Spain [email protected] FAU - Yaneva, Maria AU - Yaneva M AD - Medical University of SofiaSofia, Bulgary. FAU - Reincke, Martin AU - Reincke M AD - Medizinische Klinik und Poliklinik IVCampus Innestadt, Klinikum der Universitat Munchen, Munchen, Germany. FAU - Droste, Michael AU - Droste M AD - Praxis fur Endokrinologie DrosteOldenburg, Germany. FAU - Komerdus, Irina AU - Komerdus I AD - Moscow Regional Research Clinical InstituteMoscow, Russia. FAU - Maiter, Dominique AU - Maiter D AD - UCL Cliniques Universitaires St LucBrussels, Belgium. FAU - Kastelan, Darko AU - Kastelan D AD - Department of EndocrinologyUniversity Hospital Zagreb, School of Medicine University of Zagreb, Zagreb, Croatia. FAU - Chanson, Philippe AU - Chanson P AD - Univ Paris-SudUniversite Paris-Saclay UMR-S1185, Le Kremlin Bicetre, Paris, France. AD - Assistance Publique-Hopitaux de ParisHopital de Bicetre, Service de Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicetre, Paris, France. AD - Institut National de la Sante et de la Recherche Medicale U1185Le Kremlin Bicetre, Paris, France. FAU - Pfeifer, Marija AU - Pfeifer M AD - Department of EndocrinologyUniversity Medical Centre Ljubljana, Ljubljana, Slovenia. FAU - Strasburger, Christian J AU - Strasburger CJ AD - Division of Clinical EndocrinologyDepartment of Medicine CCM, Charite-Universitatsmedizin, Berlin, Germany. FAU - Toth, Miklos AU - Toth M AD - 2nd Department of MedicineSemmelweis University, Budapest, Hungary. FAU - Chabre, Olivier AU - Chabre O AD - Service d'Endocrinologie-Diabetologie-NutritionGrenoble Cedex, France. FAU - Tabarin, Antoine AU - Tabarin A AD - Centre Hospitalier Universitaire de BordeauxBordeaux, France. FAU - Krsek, Michal AU - Krsek M AD - 2nd Department of Internal Medicine3rd Faculty of Medicine and University Hospital Kralovske Vinohrady, Prague, Czech Republic. FAU - Fajardo, Carmen AU - Fajardo C AD - Department of EndocrinologyHospital Universitario de la Ribera, Alzira, Spain. FAU - Bolanowski, Marek AU - Bolanowski M AD - Department of EndocrinologyDiabetology and Isotope Therapy, Wroclaw Medical University, Wroclaw, Poland. FAU - Santos, Alicia AU - Santos A AD - IIB-Sant Pau and Department of Endocrinology/MedicineHospital Sant Pau, UAB, and Centro de Investigacion Biomedica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, Barcelona, Spain. FAU - Wass, John A H AU - Wass JA AD - Oxford Radcliffe Hospitals NHS TrustOxford, UK. FAU - Trainer, Peter J AU - Trainer PJ AD - Department of EndocrinologyChristie Hospital, Manchester, UK. CN - ERCUSYN Study Group LA - eng PT - Journal Article PT - Multicenter Study PT - Observational Study PL - England TA - Eur J Endocrinol JT - European journal of endocrinology JID - 9423848 RN - 9002-60-2 (Adrenocorticotropic Hormone) RN - WI4X0X7BPJ (Hydrocortisone) SB - IM MH - Adrenocorticotropic Hormone/metabolism MH - Adult MH - Aged MH - Cushing Syndrome/*diagnosis/epidemiology/*metabolism MH - Diagnostic Tests, Routine/*standards/utilization MH - Europe/epidemiology MH - Female MH - Humans MH - Hydrocortisone/metabolism MH - Male MH - Middle Aged MH - Practice Guidelines as Topic/*standards MH - *Registries MH - Statistics as Topic/methods EDAT- 2017/04/06 06:00 MHDA- 2017/04/14 06:00 CRDT- 2017/04/06 06:00 PHST- 2016/11/24 [received] PHST- 2017/02/13 [revised] PHST- 2017/02/21 [accepted] AID - 176/5/613 [pii] AID - 10.1530/EJE-16-0967 [doi] PST - ppublish SO - Eur J Endocrinol. 2017 May;176(5):613-624. doi: 10.1530/EJE-16-0967.
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