Introduction: Endogenous Cushings syndrome (CS) results from chronic excessive cortisol secretion. Discovering the source of disease is very important, but non-invasive tests cannot always be enough at the determination of correct location. We need more novel markers for distinguishing adrenal Cushing (AC) and pituitary Cushing (CD). We conducted this study for evaluating usefullness of preoperative DHEA-S levels at differentiating AC and CD.
Material and methods: We attended 78 endogenous CS cases who was diagnosed between 2010 and 2013 at Ankara Numune Education and Research hospital. All AC cases were at remission after surrenalectomy, and CD cases were either at remission after pituitary operation or that were indicated as CD because of IPSS results. We recorded preoperative morning ACTH,DHEA-S levels from the our hospital database.
Results: There was 58 female (%74.3), and 20 male (%25.7) cases. There was no difference at sex rates for two groups. The mean age of two groups were similar (CD 42.76±12.3, AC 44.8±12.1). ACTH levels were significantly higher at CD group (78.73±51.7 vs 5.63±5.7 pg/ml, P:0.00). DHEA-S levels were also significantly higher at CD group (254±189.9 vs 55.86±41.1 μg/dl, P:0.01).
We found that the level of DHEA-S 108.5 μg/dL was an apporiate cut-off point for distinguishing CD and AC. Levels above of this cut-off has reached %78.5 sensitivity and %92.3 specificity for CD.
Three cases whose ACTH level was between 5 and 20 pg/ml had DHEA-S levels below 108 μg/dl. Two of these were AC.
Conclusion: DHEA-S, is an androjen hormone which secreted from adrenal cortex by the stimulation of ACTH. Recently a publication has reported the potential of postoperative DHEA-S levels for demonstrating remission at CD. We found preoperative DHEA-S levels were significantly difference between CD and AC with a high sensitivity and specificity at the level of 108 μg/dl.
03 - 07 May 2014
European Society of Endocrinology