Utility of Simple and Non-Invasive Strategies Alternative to Inferior Petrosal Sinus Sampling and Peripheral CRH Stimulation in Differential Diagnosis of ACTH-Dependent Cushing Syndrome
Horm Metab Res DOI: 10.1055/a-2236-0864We aimed to evaluate the utility of simple, cost-effective, and non-invasive
strategies alternative to BIPSS and peripheral CRH stimulation in differential
diagnosis of ACTH-dependent CS. First, we performed ROC analysis to evaluate the
performance of various tests for differential diagnosis of ACTH-dependent CS in
our cohort (CD, n=76 and EAS, n=23) and derived their optimal
cut-offs. Subsequently, combining various demographic (gender), clinical
(hypokalemia), biochemical (plasma ACTH, HDDST, peripheral CRH stimulation) and
imaging (MRI pituitary) parameters, we derived non-invasive models with
100% PPV for CD. Patients with pituitary macroadenoma (n=14)
were excluded from the analysis involving non-invasive models. Relative percent
ACTH (AUC: 0.933) and cortisol (AUC: 0.975) increase on peripheral CRH
stimulation demonstrated excellent accuracy in discriminating CD from EAS. Best
cut-offs for CD were plasma ACTH<97.3 pg/ml,
HDDST≥57% cortisol suppression, CRH
stimulation≥77% ACTH increase and≥11% cortisol
increase. We derived six models that provided 100% PPV for CD and
precluded the need for BIPPS in 35/85 (41.2%) patients with
ACTH-dependent CS and no macroadenoma (in whom BIPSS would have otherwise been
recommended). The first three models incl...
Source: Hormone and Metabolic Research - Category: Endocrinology Authors: Attri, Bhawna Goyal, Alpesh Kalaivani, Mani Kandasamy, Devasenathipathy Gupta, Yashdeep Agarwal, Shipra Shamim, Shamim A. Damle, Nishikant Sharma, Mehar Chand Jyotsna, Viveka P. Suri, Ashish Tandon, Nikhil Tags: Original Article: Endocrine Care Source Type: research