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Diagnostic tests for Cushing's syndrome differ from published guidelines: data from ERCUSYN.

IIB-Sant Pau and Department of Endocrinology/MedicineHospital Sant Pau, UAB, and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, Barcelona, Spain. Lohmann & Birkner Health Care Consulting GmbHBerlin, Germany. Aix-Marseille UniversitéCNRS, CRN2M UMR 7286, and APHM, Hôpital Conception, Marseille, France. Erasmus University Medical CentreRotterdam, The Netherlands. Radboud University Medical CentreNijmegen, The Netherlands. Athens Polyclinic General HospitalEvangelismos Hospital, Athens, Greece. Medical University of SofiaSofia, Bulgary. Medizinische Klinik und Poliklinik IVCampus Innestadt, Klinikum der Universität München, München, Germany. Praxis für Endokrinologie DrosteOldenburg, Germany. Moscow Regional Research Clinical InstituteMoscow, Russia. UCL Cliniques Universitaires St LucBrussels, Belgium. Department of EndocrinologyUniversity Hospital Zagreb, School of Medicine University of Zagreb, Zagreb, Croatia. Univ Paris-SudUniversité Paris-Saclay UMR-S1185, Le Kremlin Bicêtre, Paris, France. Assistance Publique-Hôpitaux de ParisHôpital de Bicêtre, Service de Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre, Paris, France. Institut National de la Santé et de la Recherche Médicale U1185Le Kremlin Bicêtre, Paris, France. Department of EndocrinologyUniversity Medical Centre Ljubljana, Ljubljana, Slovenia. Division of Clinical EndocrinologyDepartment of Medicine CCM, Charité-Universitätsmedizin, Berlin, Germany. 2nd Department of MedicineSemmelweis University, Budapest, Hungary. Service d'Endocrinologie-Diabétologie-NutritionGrenoble Cedex, France. Centre Hospitalier Universitaire de BordeauxBordeaux, France. 2nd Department of Internal Medicine3rd Faculty of Medicine and University Hospital Kralovske Vinohrady, Prague, Czech Republic. Department of EndocrinologyHospital Universitario de la Ribera, Alzira, Spain. Department of EndocrinologyDiabetology and Isotope Therapy, Wroclaw Medical University, Wroclaw, Poland. Oxford Radcliffe Hospitals NHS TrustOxford, UK. Department of EndocrinologyChristie Hospital, Manchester, UK.

European journal of endocrinology. 2017;(5):613-624
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Abstract

OBJECTIVE To evaluate which tests are performed to diagnose hypercortisolism in patients included in the European Registry on Cushing's syndrome (ERCUSYN), and to examine if their use differs from the current guidelines. PATIENTS AND METHODS We analyzed data on the diagnostic tests performed in 1341 patients with Cushing's syndrome (CS) who have been entered into the ERCUSYN database between January 1, 2000 and January 31, 2016 from 57 centers in 26 European countries. Sixty-seven percent had pituitary-dependent CS (PIT-CS), 24% had adrenal-dependent CS (ADR-CS), 6% had CS from an ectopic source (ECT-CS) and 3% were classified as having CS from other causes (OTH-CS). RESULTS Of the first-line tests, urinary free cortisol (UFC) test was performed in 78% of patients, overnight 1 mg dexamethasone suppression test (DST) in 60% and late-night salivary cortisol (LSaC) in 25%. Use of LSaC increased in the last five years as compared with previous years (P < 0.01). Use of HDDST was slightly more frequent in the last 5 years as compared with previous years (P < 0.05). Of the additional tests, late-night serum cortisol (LSeC) was measured in 62% and 48-h 2 mg/day low-dose dexamethasone suppression test (LDDST) in 33% of cases. ACTH was performed in 78% of patients. LSeC and overnight 1 mg DST supported the diagnosis of both PIT-CS and ADR-CS more frequently than UFC (P < 0.05). CONCLUSIONS Use of diagnostic tests for CS varies across Europe and partly differs from the currently available guidelines. It would seem pertinent that a European consensus be established to determine the best diagnostic approach to CS, taking into account specific inter-country differences with regard to the availability of diagnostic tools.

Methodological quality

Publication Type : Multicenter Study ; Observational Study

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