Abstract | OBJECTIVE: DESIGN: Prospective cohort study. SETTING: Tertiary care research hospital. PATIENTS: A total of 58 adults referred for evaluation of mild hypercortisolism (urine free cortisol level < 1000 nmol/d). The diagnosis of Cushing's syndrome was confirmed at surgery in 39 patients. The diagnosis of a pseudo-Cushing's state was made in 19 patients on the basis of extended follow-up (mean, 28 months) without progression of cushingoid features. INTERVENTION: The low-dose dexamethasone suppression test, the CRH stimulation test, and the CRH stimulation test started 2 hours after completion of low-dose dexamethasone suppression (the dexamethasone-CRH test) were performed in all patients. MAIN OUTCOME MEASURES: RESULTS: The low-dose dexamethasone suppression test had 74% specificity, 69% sensitivity, and 71% diagnostic accuracy, using the standard criterion (17-hydroxycorticosteroid excretion level > 11.0 mumol/d on the second day of dexamethasone administration). With a urine free cortisol criterion for Cushing's syndrome of greater than 100 nmol/d, the low-dose dexamethasone suppression test had 100% specificity, 56% sensitivity, and 71% diagnostic accuracy. The CRH stimulation test without dexamethasone pretreatment had 100% specificity, 64% sensitivity, and 76% diagnostic accuracy. The diagnostic accuracy of the dexamethasone-CRH test for Cushing's syndrome was significantly greater than the accuracy of either the low-dose dexamethasone test or the CRH test alone (P < .01). A plasma cortisol concentration greater than 38 nmol/L measured 15 minutes after the administration of CRH correctly identified all cases of Cushing's syndrome and all cases of pseudo-Cushing's states (100% specificity, sensitivity, and diagnostic accuracy). CONCLUSION:
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Authors | J A Yanovski, G B Cutler Jr, G P Chrousos, L K Nieman |
Journal | JAMA
(JAMA)
Vol. 269
Issue 17
Pg. 2232-8
(May 05 1993)
ISSN: 0098-7484 [Print] United States |
PMID | 8386285
(Publication Type: Comparative Study, Journal Article)
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Chemical References |
- 17-Hydroxycorticosteroids
- Dexamethasone
- Adrenocorticotropic Hormone
- Corticotropin-Releasing Hormone
- Creatinine
- Hydrocortisone
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Topics |
- 17-Hydroxycorticosteroids
(urine)
- ACTH Syndrome, Ectopic
(diagnosis)
- Adrenocorticotropic Hormone
(blood)
- Adult
- Corticotropin-Releasing Hormone
(administration & dosage)
- Creatinine
(urine)
- Cushing Syndrome
(diagnosis, metabolism)
- Dexamethasone
(administration & dosage)
- Diagnosis, Differential
- Drug Administration Schedule
- Female
- Humans
- Hydrocortisone
(blood, urine)
- Male
- Middle Aged
- Prospective Studies
- Sensitivity and Specificity
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