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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.
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Journal Title european journal of endocrinology
Publication Year Start




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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