Clinical and biochemical data for the diagnosis of endogenous hypercortisolism: the [ldquo]Cushingomic[rdquo] approach

Filippo Ceccato; Alessandro Bavaresco; Eugenio Ragazzi; Mattia Barbot; Marco Boscaro; Daniela Basso; Scaroni Carla; Giorgia Antonelli

doi:10.1530/endoabs.99.EP741

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Endocrine Abstracts (2024) 99 EP741 | DOI: 10.1530/endoabs.99.EP741

ECE2024 Eposter Presentations Adrenal and Cardiovascular Endocrinology (155 abstracts)

Clinical and biochemical data for the diagnosis of endogenous hypercortisolism: the “Cushingomic” approach

Filippo Ceccato ¹ , Alessandro Bavaresco ¹ , Eugenio Ragazzi ¹ , Mattia Barbot ¹ , Marco Boscaro ¹ , Daniela Basso ¹ , Scaroni Carla ¹ & Giorgia Antonelli ¹

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¹University of Padova, Italy

Background: The recommended first-line screening tests for Cushing’s syndrome (CS) are serum cortisol after 1-mg dexamethasone suppression test (F^DST), urinary free cortisol (UFC), and late-night salivary cortisol (LNSC). CS is often diagnosed late: the clinical presentation of endogenous hypercortisolism overlaps with common clinical conditions.

Methods: We analyzed the diagnostic test accuracy of F^DST, UFC, and LNSC in patients without CS (263 suspected CS, 319 adrenal incidentaloma, and 33 pituitary incidentaloma) and 40 with CS. Non-parametric multivariate methods (principal component analysis, K-means clustering, random forest, and supervised learning algorithm) were used to compute an integrated analysis among screening tests (sF^DST, UFC, LNSC), cortisol-related comorbidities and signs-symptoms of CS.

Findings: The three tests were able to individuate CS, F^DST and UFC were slightly superior to LNSC. The threshold of F^DST should be adapted to the population considered, especially in adrenal incidentaloma with mild autonomous cortisol secretion. The diagnostic accuracy of UFC and LNSC was independent of the group or high-risk condition considered. Some cortisol-related chief complaints (diabetes, hypertension, and obesity) were more common in patients without CS: the direction of their vectors was not aligned and their correlation with screening tests was poor. A neural network model that combined screening tests and clinical presentation was able to predict the CS diagnosis in the validation cohort with 99% sensitivity, 86% specificity, 99% precision, and 86% accuracy.

Interpretation: Screening tests for CS performed adequately. The presence of cortisol-related comorbidities and mild autonomous cortisol secretion should be interpreted carefully.