High-dose dexamethasone suppression test is inferior to pituitary dynamic enhanced MRI in the differential diagnosis of ACTH-dependent Cushing's syndrome.

Xiaoli Shi,Dan Zhu,Xuefeng Yu,Tingting Du,Juan Chen,Kun Dong,Xuemin Peng,Jiaojiao Huang,Ting Lei,Yan Yang,Delin Ma

doi:10.1007/s12020-021-02891-y

Xiaoli Shi, Dan Zhu + Show 9 more

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https://doi.org/10.1007/s12020-021-02891-y

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The differential diagnosis of adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome remains a challenge in clinical practice. The present study was aimed at assessing the diagnostic performance of pituitary dynamic contrast-enhanced magnetic resonance imaging (dMRI), high-dose dexamethasone suppression test (HDDST), and a combination of both tests for patients with ACTH-dependent Cushing's syndrome. A total of 119 consecutive patients with ACTH-dependent Cushing's syndrome confirmed surgically were enrolled: 101 with proven Cushing's disease and 18 with proven ectopic ACTH syndrome. All patients underwent pituitary dMRI and HDDST. The sensitivity and specificity of pituitary dMRI, HDDST, and a combination of both tests were determined. The sensitivity and specificity of pituitary dMRI for diagnosing Cushing's disease were 80.2 and 83.3%, respectively, with a positive predictive value of 96.4%. The sensitivity and specificity of HDDST were 70.3 and 77.8%, respectively, with positive predictive value of 94.7%. A combination of both tests showed that the combined criteria of more than 50% suppression of serum cortisol on HDDST and a positive pituitary dMRI finding yielded a high specificity of 94.4 and sensitivity of 59.4%. The combined criteria of more than 68% suppression on HDDST and/or a positive pituitary dMRI finding yielded a sensitivity of 86.1% and specificity of 83.3%. Pituitary dMRI was superior to HDDST in the differential diagnosis of ACTH-dependent Cushing's syndrome. HDDST is recommended in combination with pituitary dMRI to establish a diagnosis process because of the significantly increased specificity with the combination.

Highlights

Cushing's syndrome (CS) is a clinical state caused by adrenal gland secreting excessive glucocorticoid
Regarding the combination of both tests, the combined criteria of a more than 50% suppression of serum cortisol in High-dose dexamethasone test (HDDST) and a positive finding in pituitary dynamic-enhanced MRI (dMRI) had given a high specificity of 94.4% and a sensitivity of 59.4%
The combined criteria of a greater than 68% suppression in HDDST and/or a positive finding in pituitary dMRI, provide a sensitivity of 86.1% and a specificity of 83.3%

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Introduction

Cushing's syndrome (CS) is a clinical state caused by adrenal gland secreting excessive glucocorticoid. It can be divided into adrenocorticotropic hormone (ACTH)-dependent Cushing’s syndrome and ACTH independent Cushing’s syndrome. ACTH-dependent Cushing syndrome is caused by tumors that produce ACTH. The diagnosis of ACTH-dependent Cushing’s syndrome could be a challenge in clinical practice. Bilateral inferior petrosal sinus sampling (BIPSS) is an accurate method with high sensitivity and specificity to distinguish CD and EAS[1]. The noninvasive examinations play an important role in clinical practice

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