Session: SAT 26-40-Glucocorticoid Actions & Disease
Poster Board SAT-31
We conducted a retrospective and multicenter study from January 2000 to May 2012. A total of 109 patients with endogenous Cushing’s syndrome were recruited. We excluded 17 patients with ectopic Cushing’s syndrome, recurrent Cushing’s syndrome, cyclic Cushing’s syndrome and subclinical Cushing’s syndrome. Serum cortisol or 24 hour urine free cortisol (UFC) after HDST (2mg per 6 hours for 2 days) and serum DHEA-S levels were measured.
Ninety-two patients were included in final analysis. Of them, 57 patients had adrenal Cushing’s syndrome and 35 patients had Cushing’s disease. Median age was 40 years in both groups. In receiver operating characteristic analysis, the area under the curve (AUC) of plasma ACTH, DHEA-S and percent suppression of serum cortisol or UFC after HDST were 0.954, 0.841, 0.950 and 0.997, repectively (all P <0.001). The cut-off value of plasma ACTH and percent suppression of serum cortisol or UFC after HDST was 24 pg/ml (normal range, 10 ~ 60 pg/ml), 33.3% and 61.6%. The sensitivity and specificity of plasma ACTH were 84.2%, 94.3%, and those of serum cortisol or UFC after HDST were 95.8%, 90.6% and 97.9%, 96.7%, respectively. Three patients with adrenal incidentalomas and non-suppressed plasma ACTH levels were successfully diagnosed with HDST.
In the present study, there was an overlap in plasma ACTH levels between patients with adrenal Cushing’s syndrome and those with Cushing’s disease. The high dose dexamethasone suppression test may be useful in etiological diagnosis of Cushing’s syndrome, especially when plasma ACTH levels alone were inconclusive.
Nothing to Disclose: ARK, ARH, KYJ, JHK, SWK, SYK
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