Limited Diagnostic Utility of Plasma Adrenocorticotropic Hormone for Differentiation between Adrenal Cushing Syndrome and Cushing Disease.
10.3803/EnM.2015.30.3.297
- Author:
A Ram HONG
1
;
Jung Hee KIM
;
Eun Shil HONG
;
I Kyeong KIM
;
Kyeong Seon PARK
;
Chang Ho AHN
;
Sang Wan KIM
;
Chan Soo SHIN
;
Seong Yeon KIM
Author Information
1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. seongyk@plaza.snu.ac.kr
- Publication Type:Multicenter Study ; Original Article
- Keywords:
Adrenal Cushing syndrome;
Cushing disease;
Adrenocorticotropic hormone;
High-dose dexamethasone suppression test;
Dehydroepiandrosterone sulfate
- MeSH:
Adrenocorticotropic Hormone*;
Cushing Syndrome*;
Dehydroepiandrosterone Sulfate;
Dexamethasone;
Diagnosis, Differential;
Diagnostic Tests, Routine;
Humans;
Hydrocortisone;
Pituitary ACTH Hypersecretion*;
Plasma*;
Retrospective Studies;
Sensitivity and Specificity
- From:Endocrinology and Metabolism
2015;30(3):297-304
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Measurement of the plasma adrenocorticotropic hormone (ACTH) level has been recommended as the first diagnostic test for differentiating between ACTH-independent Cushing syndrome (CS) and ACTH-dependent CS. When plasma ACTH values are inconclusive, a differential diagnosis of CS can be made based upon measurement of the serum dehydroepiandrosterone sulfate (DHEA-S) level and results of the high-dose dexamethasone suppression test (HDST). The aim of this study was to assess the utility of plasma ACTH to differentiate adrenal CS from Cushing' disease (CD) and compare it with that of the HDST results and serum DHEA-S level. METHODS: We performed a retrospective, multicenter study from January 2000 to May 2012 involving 92 patients with endogenous CS. The levels of plasma ACTH, serum cortisol, 24-hour urine free cortisol (UFC) after the HDST, and serum DHEA-S were measured. RESULTS: Fifty-seven patients had adrenal CS and 35 patients had CD. The area under the curve of plasma ACTH, serum DHEA-S, percentage suppression of serum cortisol, and UFC after HDST were 0.954, 0.841, 0.950, and 0.997, respectively (all P<0.001). The cut-off values for plasma ACTH, percentage suppression of serum cortisol, and UFC after HDST were 5.3 pmol/L, 33.3%, and 61.6%, respectively. The sensitivity and specificity of plasma ACTH measurement were 84.2% and 94.3%, those of serum cortisol were 95.8% and 90.6%, and those of UFC after the HDST were 97.9% and 96.7%, respectively. CONCLUSION: Significant overlap in plasma ACTH levels was seen between patients with adrenal CS and those with CD. The HDST may be useful in differentiating between these forms of the disease, especially when the plasma ACTH level alone is not conclusive.
