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The conundrum of differentiating Cushing's syndrome from non-neoplastic hypercortisolism: a systematic review and meta-analysis.

Authors :
Hinojosa-Amaya JM
González-Colmenero FD
Alvarez-Villalobos NA
Salcido-Montenegro A
Quintanilla-Sánchez C
Moreno-Peña PJ
Manzanares-Gallegos DM
Gutiérrez-Dávila LF
Castillo-Morales PL
García-Campa M
González-González JG
Varlamov E
Rodriguez-Gutiérrez R
Fleseriu M
Source :
Pituitary [Pituitary] 2024 Aug; Vol. 27 (4), pp. 345-359. Date of Electronic Publication: 2024 Jun 18.
Publication Year :
2024

Abstract

Context: Once hypercortisolemia is confirmed, differential diagnosis between Cushing's syndrome (CS) due to neoplastic endogenous hypercortisolism and non-neoplastic hypercortisolism (NNH, pseudo-Cushing's syndrome) is crucial. Due to worldwide corticotropin-releasing hormone (CRH) unavailability, accuracy of alternative tests to dexamethasone (Dex)-CRH, is clearly needed.<br />Objective: Assess the diagnostic accuracy of Dex-CRH test, desmopressin stimulation test, midnight serum cortisol (MSC), and late-night salivary cortisol (LNSC) levels to distinguish CS from NNH.<br />Methods: Articles through March 2022 were identified from Scopus, Web of Science, MEDLINE, EMBASE, and PubMed. All steps through the systematic review were performed independently and in duplicate and strictly adhered to the updated PRISMA-DTA checklist.<br />Data Synthesis: A total of 24 articles (1900 patients) were included. Dex-CRH had a pooled sensitivity and specificity of 91% (95%CI 87-94%; I <superscript>2</superscript> 0%) and 82% (73-88%; I <superscript>2</superscript> 50%), desmopressin test 86% (81-90%; I <superscript>2</superscript> 28%) and 90% (84-94%; I <superscript>2</superscript> 15%), MSC 91% (85-94%; I <superscript>2</superscript> 66%) and 81% (70-89%; I <superscript>2</superscript> 71%), and LNSC 80% (67-89%; I <superscript>2</superscript> 57%) and 90% (84-93%; I <superscript>2</superscript> 21%), respectively. Summary receiver operating characteristics areas under the curve were Dex-CRH 0.949, desmopressin test 0.936, MSC 0.942, and LNSC 0.950 without visual or statistical significance. The overall risk of studies bias was moderate.<br />Conclusion: Dex-CRH, the desmopressin stimulation test, and MSC have similar diagnostic accuracy, with Dex-CRH and MSC having slightly higher sensitivity, and the desmopressin test being more specific. LNSC was the least accurate, probably due to high heterogeneity, intrinsic variability, different assays, and lack of consistent reported cutoffs. When facing this challenging differential diagnosis, the results presented here should increase clinicians' confidence when deciding which test to perform.<br /> (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Details

Language :
English
ISSN :
1573-7403
Volume :
27
Issue :
4
Database :
MEDLINE
Journal :
Pituitary
Publication Type :
Academic Journal
Accession number :
38888685
Full Text :
https://doi.org/10.1007/s11102-024-01408-w