University of Padua

Dynamic testing for differential diagnosis of ACTH-dependent Cushing Syndrome: a systematic review and meta-analysis

Ceccato, Filippo (2022) Dynamic testing for differential diagnosis of ACTH-dependent Cushing Syndrome: a systematic review and meta-analysis. [Data Collection]

Collection description

Objective Diagnostic accuracy of testing currently used for differential diagnosis of Cushing’s disease (CD) vs ectopic adrenocorticotropic hormone (ACTH) secretion (EAS) is difficult to interpret. The present study aimed to identify and evaluate diagnostic accuracy of corticotropin-releasing hormone (CRH) test, desmopressin test, and high-dose dexamethasone suppression test (HDDST) when used to establish a CD or EAS diagnosis. Design This study is a systematic review of the literature and meta-analysis. Methods MEDLINE, OVID, and Web of Science databases were searched for articles published between the years 1990-2021. Articles included described at least one test(s) (CRH, desmopressin, or HDDST) and diagnostic reference standard(s) (histopathology, petrosal sinus sampling, surgical remission, imaging, and long-term follow-up) to establish a CD or EAS diagnosis. Results Sixty-two studies were included: 43 reported use of HDDST, 32 CRH test, and 21 desmopressin test. After analysis a CRH test was found to have the highest sensitivity in detecting CD (ACTH 86.9%, 95% confidence interval [CI] 82.1-90.6, cortisol 86.2%, 95%CI 78.3-91.5) and the highest specificity in detecting EAS (ACTH 93.9%, 95%CI 87-98.3, cortisol 89.4%, 95%CI 82.8-93.7). This resulted in a high diagnostic odds ratio (58, 95%CI 43.25-77.47), large area under the curve, and a receiver-operating characteristic (ROC) of 0.934. The diagnostic accuracy of HDDST and desmopressin test(s) was lower than that of the CRH test. Conclusion The meta-analysis indicates that a patient with a positive ACTH response after a CRH test is highly likely to have CD. Further studies analysing role of dynamic testing in addition to imaging are needed.

DOI: 10.25430/
Keywords: ACTH-dependent Cushing’s syndrome; Cushing’s disease; Ectopic ACTH secretion; CRH test; desmopressin test; high-dose dexamethasone suppression test.
Subjects: Life Sciences > Physiology, Pathophysiology and Endocrinology: Organ physiology, pathophysiology, endocrinology, metabolism, ageing, tumorigenesis, cardiovascular diseases, metabolic syndromes > Molecular aspects of endocrinology
Department: Departments > Dipartimento di Medicina (DIMED)
Depositing User: Filippo Ceccato
Date Deposited: 29 Sep 2022 06:33
Last Modified: 29 Sep 2022 06:33
Type of data: Text
Collection period:
January 1990December 2021
Resource language: english
Metadata language: english
Publisher: Research Data Unipd
Date: 28 September 2022
Copyright holders: The Author

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