Ovine CRH Stimulation and 8 mg Dexamethasone Suppression Tests in 323 Patients With ACTH-Dependent Cushing's Syndrome
Authors' conclusion
CRH is a valuable tool to correctly diagnose the etiology of ACTH-dependent CS. Its current worldwide unavailability impedes optimal management of these patients.
Study context
- Population
- Patients with ACTH-dependent Cushing's syndrome (CS) (Cushing's disease (CD) or ectopic ACTH syndrome (EAS)), diagnosis confirmed by pathology or biochemical cure in 96%; tests performed 1986–2019EAS n = 78
- Participants
- 323 patients
- Comparison
- Corticotropin-releasing hormone stimulation test (CRH-ST) vs high-dose dexamethasone suppression test (HDDST) for distinguishing CD from EAS
- Outcome
- Diagnostic accuracy for CD
Methodological detailsretrospective, tertiary referral center
- Retrospective
- Tertiary referral center
Performance
As reported in the abstract
| Test or model | Diagnostic accuracy (DA) |
|---|---|
| CRH-ST | 91%, 95% CI 87-94% |
| HDDST | 75%, 95% CI 69-79% |
Diagnostic accuracy (DA)
CRH-ST91%, 95% CI 87-94%
HDDST75%, 95% CI 69-79%
Further findings
Optimal response criteria
- CRH test: increase of ACTH and/or cortisol
- ≥40%
- HDDST: suppression of cortisol
- ≥69%
- PPV of ≥40% cortisol increase during CRH test (most specific measure)
- 99%
Concordant positive CRH test and HDDST
- Subjects with concordant positive results
- 74%
- Sensitivity (Se)
- 93%
- Specificity (Sp)
- 98%
- DA
- 95%
- PPV
- 99%
- Pretest likelihood
- 85%
Proposed algorithm
- Patients with CD diagnosed, obviating inferior petrosal sinus sampling (IPSS)
- 64%
- Accuracy
- 99%
Original publication
Ovine CRH Stimulation and 8 mg Dexamethasone Suppression Tests in 323 Patients With ACTH-Dependent Cushing's Syndrome. J Clin Endocrinol Metab. Published 2 August 2023. doi:10.
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