Abstract
BackgroundHypercortisolism accounts for relevant morbidity and mortality and is often a diagnostic challenge for clinicians. A prompt diagnosis is necessary to treat Cushing’s syndrome as early as possible.ObjectiveThe aim of this study was to develop and validate a clinical model for the estimation of pre-test probability of hypercortisolism in an at-risk population.DesignWe conducted a retrospective multicenter case-control study, involving five Italian referral centers for Endocrinology (Turin, Messina, Naples, Padua and Rome). One hundred and fifty patients affected by Cushing’s syndrome and 300 patients in which hypercortisolism was excluded were enrolled. All patients were evaluated, according to current guidelines, for the suspicion of hypercortisolism.ResultsThe Cushing score was built by multivariable logistic regression, considering all main features associated with a clinical suspicion of hypercortisolism as possible predictors. A stepwise backward selection algorithm was used (final model AUC=0.873), then an internal validation was performed through ten-fold cross-validation. Final estimation of the model performance showed an average AUC=0.841, thus reassuring about a small overfitting effect. The retrieved score was structured on a 17.5-point scale: low-risk class (score value: ≤5.5, probability of disease=0.8%); intermediate-low-risk class (score value: 6-8.5, probability of disease=2.7%); intermediate-high-risk class (score value: 9-11.5, probability of disease=18.5%) and finally, high-risk class (score value: ≥12, probability of disease=72.5%).ConclusionsWe developed and internally validated a simple tool to determine pre-test probability of hypercortisolism, the Cushing score, that showed a remarkable predictive power for the discrimination between subjects with and without a final diagnosis of Cushing’s syndrome.
Highlights
Endogenous Cushing’s syndrome (CS) is defined as a complex of signs and symptoms resulting from chronic and excessive exposure to glucocorticoids [1]
One hundred and fifty patients with confirmed CS were enrolled as the case group and 300 patients in which CS was excluded were enrolled as the control group (Table 1 summarizes the differences in baseline characteristics between the two groups)
Patients with CS were characterized by a non-significant trend towards younger age when considered as a continuous measure (42.6 ± 1.1 vs 44.9 ± 1.0 years, p=0.129), which became statistically significant upon categorization (p=0.018)
Summary
Endogenous Cushing’s syndrome (CS) is defined as a complex of signs and symptoms resulting from chronic and excessive exposure to glucocorticoids [1]. The Endocrine Society (ES) guidelines for CS recommend the initial use of at least one of the following tests: 24-hour urinary free cortisol (UFC), late-night salivary cortisol (LNS-F), 1 mg overnight or 2 mg 48-hour dexamethasone suppression test (DST) [15]. All these tests proved to be quite accurate [16, 17], discordant results are still possible and not uncommon, even after the introduction of massspectrometry-based methods [18, 19]. A prompt diagnosis is necessary to treat Cushing’s syndrome as early as possible
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
