Personalized Noninvasive Diagnostic Algorithms Based on Urinary Free Cortisol in ACTH-dependant Cushing's Syndrome
Authors' conclusion
UFC accurately predicts EAS and can serve to define personalized and noninvasive diagnostic algorithms.
Study context
- Population
- Patients with ACTH-dependent CS (247 Cushing's disease (CD), 36 ectopic ACTH secretion (EAS)) evaluated 2001–2023 in 2 French university hospitals; external validation in a single-centre cohort of 105 Belgian patients247 CD, 36 EAS
- Exposure
- Baseline urinary free cortisol (UFC)-based groups for discrimination of CD from EAS
- Outcome
- Discrimination of CD from EAS by 24-h UFC
Methodological detailsmulticentre, external validation cohort
- Multicentre
- External validation cohort
Main finding
As reported in the abstract
AUC of UFC, primary study (95% CI .92-.99)
.96
AUC of UFC, validation cohort (95% CI .98-1.00)
.99
Observational data: associations, not effects.
Further findings
Prevalence of EAS by baseline UFC group
Added clinical, imaging and biochemical parameters for EAS prediction
- BIPPS added: modest improvement, C-statistic (95% CI .97-1.00)
- .99
- Did not improve EAS prediction over UFC alone
Desmopressin test
- Limited diagnostic value when not combined with CRH test
Original publication
Personalized Noninvasive Diagnostic Algorithms Based on Urinary Free Cortisol in ACTH-dependant Cushing's Syndrome. J Clin Endocrinol Metab. Published 13 April 2024. doi:10.
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