ECE2017 Eposter Presentations: Pituitary and Neuroendocrinology Neuroendocrinology (33 abstracts)
Endogenous Cushing’s syndrome ( clinical and biochemical features in a large cohort of patients
Lucio Vilar 1 , Clarice Vilar 2 , José Luciano Albuquerque 2 , Erik Trovão 1 , Ana Carolina Thé 1 , Patricia Gadelha 1 , Maíra Melo 1 , Barbara Gomes 1 , Thaíse Borges 1 , Izabela Cardoso 1 & Ruy Lyra 1
1Division of Endocrinology, Hospital das Clinicas, Federal University of Pernambuco, Recife (Pernambuco), Brazil; 2Endocrine Research Center of Pernambuco, Recife (Pernambuco), Brazil.
Patients and methods: We retrospectively analysed the clinical and biochemical characteristics of a cohort of 150 patients with endogenous Cushing’s syndrome (CS). Cushing’s disease (CD) accounted for 61.3% of cases (n=92), ectopic ACTH secretion (EAS) 7.3% (n=11), and adrenal diseases 31.3% (n=47). Among CD cases, there were 19 macroadenomas (20.6%), a female predominance (60.5%) and a median age of 33 years old (range 14–55). Bronchial carcinoid was the most frequent cause of EAS (n=7). When biochemical and clinical features were compared in cases of CD and EAS, the only significant difference was the higher frequency of hypocalemia in EAS (80% vs. 15%; P<0.001). Concerning screening tests, the sensitivities of overnight 1 mg-DST (cut-off, 1.8 μg/dl (50 mmol/l)), UFC and late night salivary cortisol (LNSC) were 94%, 90% and 96%, respectively. The combination of two of these tests yielded a sensitivity of 98% ACTH levels were normal (42%) or elevated (58%) among patients with CD; they were above the normal range in all EAS cases and <10 pg/ml in all patients with adrenal disorders. Regarding dynamic tests, HDDST had a mean sensitivity and specificity of 79/55 and 70/100%, respectively, using the supression cut-offs of >50% and >80%, respectively. The diagnostic accuracy of CRH test and desmopressin test did not significantly differ (P=0.28) in the distinction between CD and EAS. The combination of HDDST and CRH or desmopressin tests was more accurate than each test alone. The overall diagnostic accuracy of BIPPS was 94%. Pituitary MRI depicted all macroadenomas and 64% of microadenomas. CT scan and/or MRI detected 90% of bronchial carcinoid, as well as all thymic carcinoid.
Conclusion: CD and EAS cannot be accurately be distinguished based only on clinical and biochemical features. LNSC was the most sensitive screening test for CS.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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