A SINGLE SLEEPING MIDNIGHT CORTISOL HAS 100-PERCENT SENSITIVITY FOR THE DIAGNOSIS OF CUSHINGS-SYNDROME

被引:159
作者
NEWELLPRICE, J
TRAINER, P
PERRY, L
WASS, J
GROSSMAN, A
BESSER, M
机构
[1] ST BARTHOLOMEWS HOSP, DEPT ENDOCRINOL, LONDON EC1A 7BE, ENGLAND
[2] ST BARTHOLOMEWS HOSP, DEPT CHEM ENDOCRINOL, LONDON EC1A 7BE, ENGLAND
关键词
D O I
10.1111/j.1365-2265.1995.tb02918.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVE The diagnosis of Cushing's syndrome remains a major challenge in clinical endocrinology. Various screening tests are commonly used to support a biochemical diagnosis in the context of clinical suspicion. The aim of this study was to compare the sensitivity in the diagnosis of Cushing's syndrome of a single inpatient sleeping midnight cortisol to a standard 48-hour in-patient low-dose dexamethasone suppression test (LDDST) during the same admission. DESIGN A retrospective analysis was performed on 150 patients investigated in our department between the years 1970 and 1994 with a confirmed diagnosis of Cushing's syndrome. PATIENTS One hundred and fifty patients with a diagnosis of Cushing's syndrome were analysed: 110 with Cushing's disease; 12 with tumours with ectopic ACTH secretion; 8 with ACTH dependent Cushing's syndrome of so far undetermined origin; 17 with cortisol secreting adrenal tumours; 3 with adrenocortical nodular hyperplasia. Twenty normal volunteers and nine patients with non-endocrine conditions were also investigated as controls. MEASUREMENTS Plasma cortisol was measured by radioimmunoassay (RIA) in the 122 patients presenting after 1980, and by fluorimetry prior to this date. RESULTS In all the control subjects the sleeping midnight cortisol was < 50 nmol/l, below the lowest standard of the routine in-house RIA. In every patient with Cushing's syndrome the sleeping midnight cortisol was detectable with a value greater than 50 nmol/l, with a range of 70-2000 nmol/l. In contrast, in three cases, all of whom had proven Cushing's disease on histology, there was uncharacteristic complete suppression of plasma cortisol to < 50 nmol/l following the LDDST. CONCLUSION In this series of 150 cases, a single inpatient sleeping midnight cortisol above 50 nmol/l had a 100% sensitivity for the diagnosis of Cushing's syndrome, clearly different from normal subjects. In contrast, the low-dose dexamethasone suppression test had a sensitivity of 98% even when the drug was administered as an in-patient. We recommend that a low-dose dexamethasone suppression test should not be used alone for confirmation of Cushing's syndrome since it may miss 2% of cases.
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页码:545 / 550
页数:6
相关论文
共 30 条
  • [1] BESSER GM, 1972, CLINICS ENDOCRINOLOG, V1, P451
  • [2] CIRCADIAN CORTISOL SECRETORY RHYTHMS IN CUSHINGS-DISEASE
    BOYAR, RM
    WITKIN, M
    CARRUTH, A
    RAMSEY, J
    [J]. JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 1979, 48 (05) : 760 - 765
  • [3] BUTLER PWP, 1968, LANCET, V1, P1234
  • [4] CUSHINGS-SYNDROME - REVIEW OF DIAGNOSTIC-TESTS
    CRAPO, L
    [J]. METABOLISM-CLINICAL AND EXPERIMENTAL, 1979, 28 (09): : 955 - 977
  • [5] CUNNAH D, 1986, J ENDOCRINOL, V113, P123
  • [6] DIURNAL VARIATION OF 17-HYDROXYCORTICOSTEROIDS, SODIUM, POTASSIUM, MAGNESIUM AND CREATININE IN NORMAL SUBJECTS AND IN CASES OF TREATED ADRENAL INSUFFICIENCY AND CUSHINGS SYNDROME
    DOE, RP
    VENNES, JA
    FLINK, EB
    [J]. JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 1960, 20 (02) : 253 - 265
  • [7] CUSHINGS SYNDROME - PROSPECTIVE STUDY OF DIAGNOSTIC METHODS
    EDDY, RL
    JONES, AL
    GILLILAND, PF
    IBARRA, JD
    THOMPSON, JQ
    MCMURRY, JF
    [J]. AMERICAN JOURNAL OF MEDICINE, 1973, 55 (05) : 621 - 630
  • [8] PLASMA 17-HYDROXYCORTICOSTEROIDS IN CUSHINGS SYNDROME
    EKMAN, H
    HAKANSSON, B
    SJOGREN, B
    MCCARTHY, JD
    [J]. JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 1961, 21 (06) : 684 - +
  • [9] CIRCADIAN-RHYTHM OF SERUM CORTISOL IN CUSHINGS-DISEASE
    GLASS, AR
    ZAVADIL, AP
    HALBERG, F
    CORNELISSEN, G
    SCHAAF, M
    [J]. JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 1984, 59 (01) : 161 - 165
  • [10] CRF IN THE DIFFERENTIAL-DIAGNOSIS OF CUSHINGS-SYNDROME - A COMPARISON WITH THE DEXAMETHASONE SUPPRESSION TEST
    GROSSMAN, AB
    HOWLETT, TA
    PERRY, L
    COY, DH
    SAVAGE, MO
    LAVENDER, P
    REES, LH
    BESSER, GM
    [J]. CLINICAL ENDOCRINOLOGY, 1988, 29 (02) : 167 - 178