Elena Valassi1, Holger Franz2, Thierry Brue3, Richard A Feelders4, Romana Netea-Maier5, Stylianos Tsagarakis6, Susan M Webb1, Maria Yaneva7, Martin Reincke8, Michael Droste9, Irina Komerdus10, Dominique Maiter11, Darko Kastelan12, Philippe Chanson13,14,15, Marija Pfeifer16, Christian J Strasburger17, Miklós Tóth18, Olivier Chabre19, Antoine Tabarin20, Michal Krsek21, Carmen Fajardo22, Marek Bolanowski23, Alicia Santos1, John A H Wass24, Peter J Trainer25. 1. IIB-Sant Pau and Department of Endocrinology/MedicineHospital Sant Pau, UAB, and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, Barcelona, Spain. 2. Lohmann & Birkner Health Care Consulting GmbHBerlin, Germany. 3. Aix-Marseille UniversitéCNRS, CRN2M UMR 7286, and APHM, Hôpital Conception, Marseille, France. 4. Erasmus University Medical CentreRotterdam, The Netherlands. 5. Radboud University Medical CentreNijmegen, The Netherlands. 6. Athens Polyclinic General HospitalEvangelismos Hospital, Athens, Greece. 7. Medical University of SofiaSofia, Bulgary. 8. Medizinische Klinik und Poliklinik IVCampus Innestadt, Klinikum der Universität München, München, Germany. 9. Praxis für Endokrinologie DrosteOldenburg, Germany. 10. Moscow Regional Research Clinical InstituteMoscow, Russia. 11. UCL Cliniques Universitaires St LucBrussels, Belgium. 12. Department of EndocrinologyUniversity Hospital Zagreb, School of Medicine University of Zagreb, Zagreb, Croatia. 13. Univ Paris-SudUniversité Paris-Saclay UMR-S1185, Le Kremlin Bicêtre, Paris, France. 14. Assistance Publique-Hôpitaux de ParisHôpital de Bicêtre, Service de Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre, Paris, France. 15. Institut National de la Santé et de la Recherche Médicale U1185Le Kremlin Bicêtre, Paris, France. 16. Department of EndocrinologyUniversity Medical Centre Ljubljana, Ljubljana, Slovenia. 17. Division of Clinical EndocrinologyDepartment of Medicine CCM, Charité-Universitätsmedizin, Berlin, Germany. 18. 2nd Department of MedicineSemmelweis University, Budapest, Hungary. 19. Service d'Endocrinologie-Diabétologie-NutritionGrenoble Cedex, France. 20. Centre Hospitalier Universitaire de BordeauxBordeaux, France. 21. 2nd Department of Internal Medicine3rd Faculty of Medicine and University Hospital Kralovske Vinohrady, Prague, Czech Republic. 22. Department of EndocrinologyHospital Universitario de la Ribera, Alzira, Spain. 23. Department of EndocrinologyDiabetology and Isotope Therapy, Wroclaw Medical University, Wroclaw, Poland. 24. Oxford Radcliffe Hospitals NHS TrustOxford, UK. 25. Department of EndocrinologyChristie Hospital, Manchester, UK.
Abstract
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.
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.
Authors: Kalyani Sridharan; Jayaprakash Sahoo; Rajan Palui; Milind Patil; Sadishkumar Kamalanathan; A S Ramesh; N S Kubera Journal: Pituitary Date: 2021-03-29 Impact factor: 4.107
Authors: B Lechner; D Heinrich; S Nölting; A Osswald-Kopp; G Rubinstein; J Sauerbeck; F Beuschlein; M Reincke Journal: Internist (Berl) Date: 2018-11 Impact factor: 0.743
Authors: Sofia Castro Oliveira; João Sérgio Neves; Pedro Souteiro; Sandra Belo; Ana Isabel Oliveira; Helena Moreira; Paulo Mergulhão Gomes; Lígia Coelho; Cristina Sarmento; Elsa Fonseca; Celestino Neves; Paula Freitas; Davide Carvalho Journal: Case Rep Endocrinol Date: 2019-10-15
Authors: Barbara Stachowska; Justyna Kuliczkowska-Płaksej; Marcin Kałużny; Jędrzej Grzegrzółka; Maja Jończyk; Marek Bolanowski Journal: Endocrine Date: 2020-09-03 Impact factor: 3.633