An accurate non-invasive approach to diagnose Cushing´s syndrome in at risk populations

CARDOSO EML, ARREGGER AL, MONARDES G, CONTRERAS LN

STEROIDS

ELSEVIER SCIENCE INC

Lugar: Amsterdam; Año: 2012

0039-128X

Background In developing countries the prevalence of Cushing´s syndrome(CS) in patients at risk remains uncertain. Evening urinary cortisol (UFC 22-23) and salivary cortisol after 1-mg DST (SAFdex) have been seldom used in these populations. Objectives To establish the prevalence of CS in adults with cortisol related morbidities using for the first time UFC22-23 and SAFdex along with all first-line diagnostic tests recommended for CS. To assess the performance of each test and define a non invasive outpatient diagnostic approach for CS in subjects at risk. Methods 128 outpatients were studied: diabetics type 1 and 2 with poor metabolic control (DM1 and DM2), hypertensive with central obesity (HBP) and premenopausal women with osteoporosis (OS). Controls were 100 healthy volunteers and 23 CS. Total urinary cortisol (UFC), UFC22-23, late-night salivary cortisol (SAF23) and suppressed cortisol in saliva ( SAFdex) and serum (Fdex) after 1mg-DST were assessed. Results: CS was diagnosed in one DM2 and one HBP; both women with central obesity. In CS, the reproducibility of UFC showed more within person variability than UFC 22-23 and SAF 23 . UFC22-23 and SAF23 correlated positively and significantly in all groups (r≥ 0.70; p≤ 0.0001). ROC analysis demonstrated that UFC22-23, SAF23 , SAFdex and Fdex had 100% sensitivity (S) at difference of UFC (94.0% S).UFC22-23 , SAF23 and UFC reached 100% specificity. Conclusion CS was diagnosed in 1.5 % of patients at risk. The combination of UFC22-23 or SAF23 with SAFdex offers a valuable non invasive ambulatory approach to the diagnosis of CS.