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Endocrine Abstracts (2020) 70 AEP598 | DOI: 10.1530/endoabs.70.AEP598

1Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey; 2Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey; 3Kocaeli University, Faculty of Medicine, Kocaeli, Turkey; 4Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey; 5Celal Bayar University Medicine Faculty, Manisa, Turkey; 6Erciyes University Medical School, Kayseri, Turkey; 7Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey; 8İzmir Ataturk Training and Research Hospital, Division of Endocrinology and Metabolism, Izmir, Turkey; 9Division of Endocrinology and Metabolism, Ondokuz Mayıs University, Samsun, Turkey; 10Department of Endocrinology, Ege University Faculty of Medicine, Izmir, Turkey; 11Department of Endocrinology and Metabolism Diseases, Faculty of Medicine, Baskent University, Adana, Turkey; 12Division of Endocrinology and Metabolism, Ankara Training and Research Hospital, Ankara,Turkey; 13Cukurova University Faculty of Medicine, Adana, Turkey; 14Department of Endocrinology, Ministry of Health Okmeydani Research and Training Hospital, Health Sciences University, Istanbul, Turkey; 15Division of Endocrinology and Metabolism, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey; 16Department of Endocrinology and Metabolic Disease, Dr. Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey; 17Dicle University School of Medicine Adult Endocrinology Department, Diyarbakir, Turkey; 18Endocrinology and Metabolism Department, Istanbul Civilization University, Istanbul, Turkey; 19Endocrinology and Metabolism, Canakkale Onsekiz Mart Universitesi Tip Fakultesi, Canakkale, Turkey; 20Division of Endocrinology and Metabolism, Ataturk University School of Medicine, Erzurum, Turkey; 21Istanbul University, Istanbul, Turkey

Purpose: To evaluate the relationship between basal dehydroepiandrosterone-sulfate (DHEA-S) levels and other tests used in the diagnosis and differential diagnosis of Cushing’s Syndrome (CS) among the patients with pathologically confirmed CS.

Methods: In this multicenter study, the data of 623 patients with CS were evaluated retrospectively. The patients were classified as Group 1 (n = 353 Cushing’s disease;CD), Group 2 (n = 242 adrenal CS) and Group 3 (n = 28 ectopic ACTH syndrome; EAS). The groups were compared in terms of demographic data, estimated duration to diagnosis of CS, pre-operative ACTH, basal cortisol, DHEA-S, 24-hour urinary free cortisol (24 h-UFC) levels and dexamethasone suppression test (DST) results. Correlations between DHEA-S levels and all parameters were evaluated. A ROC curve was produced to calculate the optimal DHEA-S cut-off value in the differential diagnosis of CS. The effectiveness of the calculated DHEA-S cut-off level in demonstrating the accurate etiology of patients with gray zone in terms of ACTH levels (10–20 pg/ml) was assessed.

Results: The Group 1 patients were younger than the Group 2 patients (P < 0.001), while Group 3 had more male patients than the others (P < 0.001). Basal cortisol, ACTH, 24 h-UFC levels were significantly different between the three groups (Group 3>Group 1>Group 2), (P < 0.001, for all comparisons). The DHEA-S level was significantly lower in Group 2 compared to the other two groups (P < 0.001), while Group 1 and Group 3 had similar DHEA-S levels. There was a negative correlation between DHEA-S levels and age at diagnosis (r = −0.184, P < 0.0001) and high-dose DST (r = −0.133, P < 0.0001); and a positive correlation between basal cortisol (r = 0.247, P < 0.0001), ACTH (r = 0.550, P < 0.0001) and 24 h-UFC levels (r = 0.172, P < 0.0001).No significant correlation was found between DHEA-S levels and other parameters. The optimal cut-off DHEA-S value that providing differential diagnosis of CS was calculated to be 43.2 µg/dl [sensitivity of 88%(79–93%) and specificity of 76% (70–82%)] between Group 1 and Group 2. This DHEA-S cut-off level demonstrated the accurate etiology in 93% of 14 CD and 100% of 44 adrenal CS in patients with gray zone in terms of ACTH levels. The optimal DHEA-S cut-off value that providing differential diagnosis of CS was calculated to be 136.5 µg/dl [sensitivity of 91% (87–98%) and specificity of 73% (69–81%)] between Group 2 and Group 3. No significant cut-off level was found between Group 1 and Group 3.

Conclusion: This study showed that the DHEA-S cut-off value could be used for differential diagnosis of CD and adrenal CS with high sensitivity and specificity, at the initial evaluation.

Volume 70

22nd European Congress of Endocrinology

05 Sep 2020 - 09 Sep 2020

European Society of Endocrinology 

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