Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2009) 20 P580

ECE2009 Poster Presentations Neuroendocrinology, Pituitary and Behaviour (74 abstracts)

Human corticotropin releasing hormone (hCRH) test performance in the differential diagnosis between Cushing's disease and pseudo-Cushing state is enhanced by combined ACTH and cortisol analysis

Giacomo Tirabassi , Giorgio Arnaldi , Roberta Papa , Giorgio Furlani , Laura Trementino , Marina Cardinaletti , Emanuela Faloia & Marco Boscaro

Clinica di Endocrinologia, Ancona, Italy.

Objective: The corticotropin releasing hormone (CRH) test does not reliably distinguish between Cushing’s disease (CD) and normality or pseudo-Cushing state (PC). In this study we assessed whether the application of novel criteria could enhance its diagnostic performance.

Design: Retrospective study.

Patients: Fifty-one subjects with CD, 26 with PC and 31 control subjects (CT).

Measurements: All subjects underwent human CRH (hCRH) test and standard diagnostic procedures for the diagnosis of Cushing’s syndrome (CS).

Results: The area under the curve (AUC)-ACTH exhibited a significant negative correlation with baseline serum cortisol in CT and PC subjects, but not in CD patients. The ACTH response to hCRH was blunted in PC compared with CT subjects. These findings suggested that CD can be diagnosed by the simultaneous presence of two hCRH test parameters and excluded in the absence of either or both.

The two-parameter combinations proposed are (1) basal serum cortisol >331 nmol/l and absolute peak plasma ACTH>12 pmol/l, or (2) absolute peak serum cortisol>580 nmol/l and absolute peak plasma ACTH>10 pmol/l. The combined criteria had a sensitivity (SE) of 90.1 and 94.1% and a specificity (SP) of 98.2% and 91.2%, respectively.

Conclusions: The proposed combinations enabled the hCRH test to distinguish CD patients from PC and CT subjects.

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