Clinical and Biochemical Data for the Diagnosis of Endogenous Hypercortisolism: The “Cushingomic” Approach
Authors' conclusion
Despite the high diagnostic accuracy of screening tests to detect CS, cortisol-related comorbidities or AI should be considered when interpreting a positive test.
Study context
- Population
- 615 patients without Cushing syndrome (CS) (263 suspected CS, 319 adrenal and 33 pituitary incidentaloma) and 40 with CS615 without CS, 40 with CS
- Comparison
- Dexamethasone suppression test (DST) vs urinary free cortisol (UFC) vs late-night salivary cortisol (LNSC) for CS screening
- Outcome
- Diagnostic accuracy of screening tests for CS
Methodological detailsprincipal component analysis, K-means clustering, neural network
- Principal component analysis
- K-means clustering
- Neural network
Performance
As reported in the abstract
Diagnostic accuracy for CS
DST cutoff to differentiate CS in adrenal incidentaloma (AI) with mild autonomous cortisol secretion should be increased
196 nmol/L
Further findings
Comorbidities
- Diabetes, hypertension and obesity more common in patients without CS; poor correlation with screening tests
Clustering of patients without CS
- Cluster 1: aged osteoporotic patients with impaired screening tests; cluster 2: hypertensive and metabolic phenotype; cluster 3: young individuals with low likelihood of overt CS
Neural network combining screening tests and clinical presentation, validation cohort
- Precision
- 99%
- Accuracy
- 86%
Original publication
Clinical and Biochemical Data for the Diagnosis of Endogenous Hypercortisolism: The “Cushingomic” Approach. J Clin Endocrinol Metab. Published 26 July 2024. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →