The conundrum of differentiating Cushing's syndrome from non-neoplastic hypercortisolism: a systematic review and meta-analysis.

IF 3.3 2区医学 Q2 ENDOCRINOLOGY & METABOLISM Pituitary Pub Date : 2024-08-01 Epub Date: 2024-06-18 DOI:10.1007/s11102-024-01408-w

José Miguel Hinojosa-Amaya, Fernando Díaz González-Colmenero, Neri Alejandro Alvarez-Villalobos, Alejandro Salcido-Montenegro, Carolina Quintanilla-Sánchez, Pablo José Moreno-Peña, Dulce María Manzanares-Gallegos, Luis Fernando Gutiérrez-Dávila, Patricia Lizeth Castillo-Morales, Mariano García-Campa, José Gerardo González-González, Elena Varlamov, René Rodriguez-Gutiérrez, Maria Fleseriu

{"title":"The conundrum of differentiating Cushing's syndrome from non-neoplastic hypercortisolism: a systematic review and meta-analysis.","authors":"José Miguel Hinojosa-Amaya, Fernando Díaz González-Colmenero, Neri Alejandro Alvarez-Villalobos, Alejandro Salcido-Montenegro, Carolina Quintanilla-Sánchez, Pablo José Moreno-Peña, Dulce María Manzanares-Gallegos, Luis Fernando Gutiérrez-Dávila, Patricia Lizeth Castillo-Morales, Mariano García-Campa, José Gerardo González-González, Elena Varlamov, René Rodriguez-Gutiérrez, Maria Fleseriu","doi":"10.1007/s11102-024-01408-w","DOIUrl":null,"url":null,"abstract":"Context: Once hypercortisolemia is confirmed, differential diagnosis between Cushing's syndrome (CS) due to neoplastic endogenous hypercortisolism and non-neoplastic hypercortisolism (NNH, pseudo-Cushing's syndrome) is crucial. Due to worldwide corticotropin-releasing hormone (CRH) unavailability, accuracy of alternative tests to dexamethasone (Dex)-CRH, is clearly needed.Objective: Assess the diagnostic accuracy of Dex-CRH test, desmopressin stimulation test, midnight serum cortisol (MSC), and late-night salivary cortisol (LNSC) levels to distinguish CS from NNH.Methods: Articles through March 2022 were identified from Scopus, Web of Science, MEDLINE, EMBASE, and PubMed. All steps through the systematic review were performed independently and in duplicate and strictly adhered to the updated PRISMA-DTA checklist.Data synthesis: A total of 24 articles (1900 patients) were included. Dex-CRH had a pooled sensitivity and specificity of 91% (95%CI 87-94%; I2 0%) and 82% (73-88%; I2 50%), desmopressin test 86% (81-90%; I2 28%) and 90% (84-94%; I2 15%), MSC 91% (85-94%; I2 66%) and 81% (70-89%; I2 71%), and LNSC 80% (67-89%; I2 57%) and 90% (84-93%; I2 21%), respectively. Summary receiver operating characteristics areas under the curve were Dex-CRH 0.949, desmopressin test 0.936, MSC 0.942, and LNSC 0.950 without visual or statistical significance. The overall risk of studies bias was moderate.Conclusion: Dex-CRH, the desmopressin stimulation test, and MSC have similar diagnostic accuracy, with Dex-CRH and MSC having slightly higher sensitivity, and the desmopressin test being more specific. LNSC was the least accurate, probably due to high heterogeneity, intrinsic variability, different assays, and lack of consistent reported cutoffs. When facing this challenging differential diagnosis, the results presented here should increase clinicians' confidence when deciding which test to perform.","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":" ","pages":"345-359"},"PeriodicalIF":3.3000,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pituitary","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s11102-024-01408-w","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/6/18 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}

引用次数: 0

Abstract

Context: Once hypercortisolemia is confirmed, differential diagnosis between Cushing's syndrome (CS) due to neoplastic endogenous hypercortisolism and non-neoplastic hypercortisolism (NNH, pseudo-Cushing's syndrome) is crucial. Due to worldwide corticotropin-releasing hormone (CRH) unavailability, accuracy of alternative tests to dexamethasone (Dex)-CRH, is clearly needed.

Objective: Assess the diagnostic accuracy of Dex-CRH test, desmopressin stimulation test, midnight serum cortisol (MSC), and late-night salivary cortisol (LNSC) levels to distinguish CS from NNH.

Methods: Articles through March 2022 were identified from Scopus, Web of Science, MEDLINE, EMBASE, and PubMed. All steps through the systematic review were performed independently and in duplicate and strictly adhered to the updated PRISMA-DTA checklist.

Data synthesis: A total of 24 articles (1900 patients) were included. Dex-CRH had a pooled sensitivity and specificity of 91% (95%CI 87-94%; I² 0%) and 82% (73-88%; I² 50%), desmopressin test 86% (81-90%; I² 28%) and 90% (84-94%; I² 15%), MSC 91% (85-94%; I² 66%) and 81% (70-89%; I² 71%), and LNSC 80% (67-89%; I² 57%) and 90% (84-93%; I² 21%), respectively. Summary receiver operating characteristics areas under the curve were Dex-CRH 0.949, desmopressin test 0.936, MSC 0.942, and LNSC 0.950 without visual or statistical significance. The overall risk of studies bias was moderate.

Conclusion: Dex-CRH, the desmopressin stimulation test, and MSC have similar diagnostic accuracy, with Dex-CRH and MSC having slightly higher sensitivity, and the desmopressin test being more specific. LNSC was the least accurate, probably due to high heterogeneity, intrinsic variability, different assays, and lack of consistent reported cutoffs. When facing this challenging differential diagnosis, the results presented here should increase clinicians' confidence when deciding which test to perform.

Abstract Image

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

区分库欣综合征和非肿瘤性皮质醇过多症的难题：系统综述和荟萃分析。

背景：一旦确诊为高皮质醇血症，就必须对肿瘤性内源性高皮质醇增多症引起的库欣综合征（CS）和非肿瘤性高皮质醇增多症（NNH，假性库欣综合征）进行鉴别诊断。由于全球范围内都无法获得促肾上腺皮质激素释放激素（CRH），因此显然需要地塞米松（Dex）-CRH替代试验的准确性：评估地塞米松-CRH 试验、去氨加压素刺激试验、午夜血清皮质醇（MSC）和深夜唾液皮质醇（LNSC）水平对区分 CS 和 NNH 的诊断准确性：方法：从 Scopus、Web of Science、MEDLINE、EMBASE 和 PubMed 上查找截至 2022 年 3 月的文章。系统综述的所有步骤均独立完成，一式两份，并严格遵守最新的PRISMA-DTA清单：共纳入 24 篇文章（1900 名患者）。Dex-CRH 的集合灵敏度和特异性分别为 91% (95%CI 87-94%; I2 0%) 和 82% (73-88%; I2 50%), 去氨加压素试验为 86% (81-90%. I2 28%) 和 90% (95%CI 87-94%; I2 0%)；I2 28%) 和 90% (84-94%; I2 15%)，MSC 分别为 91% (85-94%; I2 66%) 和 81% (70-89%; I2 71%)，LNSC 分别为 80% (67-89%; I2 57%) 和 90% (84-93%; I2 21%)。曲线下的接收器操作特征汇总面积分别为：Dex-CRH 0.949、去氨加压素试验 0.936、MSC 0.942 和 LNSC 0.950，无直观或统计学意义。总体研究偏倚风险为中度：结论：Dex-CRH、去氨加压素刺激试验和 MSC 具有相似的诊断准确性，Dex-CRH 和 MSC 的敏感性略高，而去氨加压素试验的特异性更高。LNSC 的准确性最低，这可能是由于高度异质性、内在可变性、不同的检测方法以及缺乏一致的报告临界值。在面对这一具有挑战性的鉴别诊断时，本文介绍的结果应能增强临床医生在决定进行哪种检验时的信心。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Pituitary 医学-内分泌学与代谢

CiteScore

7.10

自引率

7.90%

发文量

审稿时长

6 months

期刊介绍： Pituitary is an international publication devoted to basic and clinical aspects of the pituitary gland. It is designed to publish original, high quality research in both basic and pituitary function as well as clinical pituitary disease. The journal considers: Biology of Pituitary Tumors Mechanisms of Pituitary Hormone Secretion Regulation of Pituitary Function Prospective Clinical Studies of Pituitary Disease Critical Basic and Clinical Reviews Pituitary is directed at basic investigators, physiologists, clinical adult and pediatric endocrinologists, neurosurgeons and reproductive endocrinologists interested in the broad field of the pituitary and its disorders. The Editorial Board has been drawn from international experts in basic and clinical endocrinology. The journal offers a rapid turnaround time for review of manuscripts, and the high standard of the journal is maintained by a selective peer-review process which aims to publish only the highest quality manuscripts. Pituitary will foster the publication of creative scholarship as it pertains to the pituitary and will provide a forum for basic scientists and clinicians to publish their high quality pituitary-related work.

期刊最新文献

Novel approach to bone comorbidity in resistant acromegaly. Hypopituitarism and COVID-19. Cushing's syndrome and COVID-19. Modern approach to bone comorbidity in prolactinoma. Approach to the patient with controlled acromegaly and acromegalic arthropathy: clinical diagnosis and management.