Dynamic Testing for Differential Diagnosis of ACTH-Dependent Cushing Syndrome: A Systematic Review and Meta-analysis
Authors' conclusion
The meta-analysis indicates that a patient with a positive ACTH response after a CRH test is highly likely to have CD. Further studies analyzing role of dynamic testing in addition to imaging are needed.
Study context
- Population
- Patients with ACTH-dependent Cushing syndrome; Cushing disease (CD) vs ectopic ACTH secretion (EAS); reference standards histopathology, petrosal sinus sampling, surgical remission, imaging, long-term follow-up; articles 1990–202162 studies
- Participants
- 32 / 21 / 43
- Comparison
- Corticotropin-releasing hormone (CRH) test vs desmopressin test vs high-dose dexamethasone suppression test (HDDST) for differentiating CD from EAS
- CRH testn = 32
- Desmopressin testn = 21
- HDDSTn = 43
- Outcome
- Diagnostic accuracy of CRH test, desmopressin test and HDDST for CD or EAS diagnosis
Methodological detailsMEDLINE, OVID and Web of Science searched, 1990–2021
- MEDLINE, OVID and Web of Science searched, 1990–2021
Pooled result
As reported in the abstract
Diagnostic accuracy for CD vs EAS
| Group | Sensitivity for CD, ACTH | Sensitivity for CD, cortisol | Specificity for EAS, ACTH | Specificity for EAS, cortisol | Diagnostic OR | ROC |
|---|---|---|---|---|---|---|
| CRH test | 86.9% (95% CI 82.1-90.6) | 86.2% (95% CI 78.3-91.5) | 93.9% (95% CI 87-98.3) | 89.4% (95% CI 82.8-93.7) | 58 (95% CI 43.25-77.47) | 0.934 |
CRH test
Sensitivity for CD, ACTH86.9% (95% CI 82.1-90.6)
Sensitivity for CD, cortisol86.2% (95% CI 78.3-91.5)
Specificity for EAS, ACTH93.9% (95% CI 87-98.3)
Specificity for EAS, cortisol89.4% (95% CI 82.8-93.7)
Diagnostic OR58 (95% CI 43.25-77.47)
ROC0.934
Original publication
Dynamic Testing for Differential Diagnosis of ACTH-Dependent Cushing Syndrome: A Systematic Review and Meta-analysis. J Clin Endocrinol Metab. Published 1 December 2022. doi:10.
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