The Conundrum of Differentiating Cushing’s syndrome from Non-Neoplastic hypercortisolism: A Systematic Review and Meta-analysis
Context: Differential diagnosis between Cushing’s syndrome (CS) due to neoplastic endogenous hypercortisolism and non-neoplastic hypercortisolism (NNH, pseudo-Cushing’s syndrome) is crucial. Due to worldwide corticotropin-releasing hormone test CRH shortage, accuracy of alternative tests to Dexamet...
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| Formato: | Otro |
| Lenguaje: | inglés |
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Facultad de Medicina UANL
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| Acceso en línea: | http://eprints.uanl.mx/27512/7/27512X.pdf |
| _version_ | 1824420758543138816 |
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| author | Hinojosa Amaya, José Miguel González Colmenero, Fernando Díaz Alvarez Villalobos, Neri Alejandro Salcido Montenegro, Alejandro Quintanilla Sánchez, Carolina Moreno Peña, Pablo José Manzanares Gallegos, Dulce María Gutiérrez Dávila, Luis Fernando Castillo Morales, Patricia Lizeth García Campa, Mariano González González, José Gerardo Varlamov, Elena V. Rodríguez Gutiérrez, René Fleseriu, Maria |
| author_facet | Hinojosa Amaya, José Miguel González Colmenero, Fernando Díaz Alvarez Villalobos, Neri Alejandro Salcido Montenegro, Alejandro Quintanilla Sánchez, Carolina Moreno Peña, Pablo José Manzanares Gallegos, Dulce María Gutiérrez Dávila, Luis Fernando Castillo Morales, Patricia Lizeth García Campa, Mariano González González, José Gerardo Varlamov, Elena V. Rodríguez Gutiérrez, René Fleseriu, Maria |
| author_sort | Hinojosa Amaya, José Miguel |
| collection | Repositorio Institucional |
| description | Context: Differential diagnosis between Cushing’s syndrome (CS) due to neoplastic endogenous hypercortisolism and non-neoplastic hypercortisolism (NNH, pseudo-Cushing’s syndrome) is crucial. Due to worldwide corticotropin-releasing hormone test CRH shortage, accuracy of alternative tests to Dexamethasone (Dex)-CRH is clearly needed.
Objective: Asses the diagnostic accuracy of Dex-CRH, desmopressin stimulation test, midnight serum cortisol (MSC), and late-night salivary cortisol (LNSC) levels to distinguish CS from NNH.
Methods: Articles through March 2022 were identified from Scopus, Web of Science, MEDLINE, EMBASE, and PubMed. All steps through the systematic review were performed independently and in duplicate and strictly adhered to the updated PRISMA-DTA checklist.
Data Synthesis: A total of 26 articles (2059 patients) were included. Dex-CRH had a pooled sensitivity and specificity of 91% (95%CI 87-94%; I2 0%) and 82% (73-88%; I2 50%), desmopressin test 87% (81-91%; I2 34%) and 91% (85-94%; I2 15%), MSC 91% (85-94%; I2 65%) and 80% (70-88%; I2 70%), and LNSC 78% (66-86%; I2 54%) and 88% (83-92%; I2 36%), respectively. SROC areas under the curve were Dex-CRH 0.949, desmopressin test 0.941, MSC 0.939, and LNSC 0.940 without visual or statistical significance. The overall risk of studies bias was moderate.
Conclusion: Dex-CRH, the desmopressin stimulation test, and MSC have similar diagnostic accuracy, with Dex-CRH and MSC having slightly higher sensitivity, and the desmopressin test being more specific. LNSC was the least accurate, probably due to high heterogeneity, intrinsic variability, different assays, and lack of consistent reported cutoffs. Our results should increase clinicians’ confidence when deciding which test to perform when facing this challenging differential diagnosis.
Key Words: Cushing’s syndrome, neoplastic endogenous hypercortisolism, non-neoplastic hypercortisolism, pseudoCushing’s, dexamethasone CRH test, desmopressin test, salivary cortisol, midnight serum cortisol |
| format | Otro |
| id | eprints-27512 |
| institution | UANL |
| language | English |
| publisher | Facultad de Medicina UANL |
| record_format | eprints |
| spelling | eprints-275122024-12-11T14:44:26Z http://eprints.uanl.mx/27512/ The Conundrum of Differentiating Cushing’s syndrome from Non-Neoplastic hypercortisolism: A Systematic Review and Meta-analysis Hinojosa Amaya, José Miguel González Colmenero, Fernando Díaz Alvarez Villalobos, Neri Alejandro Salcido Montenegro, Alejandro Quintanilla Sánchez, Carolina Moreno Peña, Pablo José Manzanares Gallegos, Dulce María Gutiérrez Dávila, Luis Fernando Castillo Morales, Patricia Lizeth García Campa, Mariano González González, José Gerardo Varlamov, Elena V. Rodríguez Gutiérrez, René Fleseriu, Maria RC Medicina Interna, Psiquiatría, Neurología Context: Differential diagnosis between Cushing’s syndrome (CS) due to neoplastic endogenous hypercortisolism and non-neoplastic hypercortisolism (NNH, pseudo-Cushing’s syndrome) is crucial. Due to worldwide corticotropin-releasing hormone test CRH shortage, accuracy of alternative tests to Dexamethasone (Dex)-CRH is clearly needed. Objective: Asses the diagnostic accuracy of Dex-CRH, desmopressin stimulation test, midnight serum cortisol (MSC), and late-night salivary cortisol (LNSC) levels to distinguish CS from NNH. Methods: Articles through March 2022 were identified from Scopus, Web of Science, MEDLINE, EMBASE, and PubMed. All steps through the systematic review were performed independently and in duplicate and strictly adhered to the updated PRISMA-DTA checklist. Data Synthesis: A total of 26 articles (2059 patients) were included. Dex-CRH had a pooled sensitivity and specificity of 91% (95%CI 87-94%; I2 0%) and 82% (73-88%; I2 50%), desmopressin test 87% (81-91%; I2 34%) and 91% (85-94%; I2 15%), MSC 91% (85-94%; I2 65%) and 80% (70-88%; I2 70%), and LNSC 78% (66-86%; I2 54%) and 88% (83-92%; I2 36%), respectively. SROC areas under the curve were Dex-CRH 0.949, desmopressin test 0.941, MSC 0.939, and LNSC 0.940 without visual or statistical significance. The overall risk of studies bias was moderate. Conclusion: Dex-CRH, the desmopressin stimulation test, and MSC have similar diagnostic accuracy, with Dex-CRH and MSC having slightly higher sensitivity, and the desmopressin test being more specific. LNSC was the least accurate, probably due to high heterogeneity, intrinsic variability, different assays, and lack of consistent reported cutoffs. Our results should increase clinicians’ confidence when deciding which test to perform when facing this challenging differential diagnosis. Key Words: Cushing’s syndrome, neoplastic endogenous hypercortisolism, non-neoplastic hypercortisolism, pseudoCushing’s, dexamethasone CRH test, desmopressin test, salivary cortisol, midnight serum cortisol Facultad de Medicina UANL Otro NonPeerReviewed text en cc_by_nc_nd http://eprints.uanl.mx/27512/7/27512X.pdf http://eprints.uanl.mx/27512/7.haspreviewThumbnailVersion/27512X.pdf Hinojosa Amaya, José Miguel y González Colmenero, Fernando Díaz y Alvarez Villalobos, Neri Alejandro y Salcido Montenegro, Alejandro y Quintanilla Sánchez, Carolina y Moreno Peña, Pablo José y Manzanares Gallegos, Dulce María y Gutiérrez Dávila, Luis Fernando y Castillo Morales, Patricia Lizeth y García Campa, Mariano y González González, José Gerardo y Varlamov, Elena V. y Rodríguez Gutiérrez, René y Fleseriu, Maria The Conundrum of Differentiating Cushing’s syndrome from Non-Neoplastic hypercortisolism: A Systematic Review and Meta-analysis. Facultad de Medicina UANL. (Sin publicar) |
| spellingShingle | RC Medicina Interna, Psiquiatría, Neurología Hinojosa Amaya, José Miguel González Colmenero, Fernando Díaz Alvarez Villalobos, Neri Alejandro Salcido Montenegro, Alejandro Quintanilla Sánchez, Carolina Moreno Peña, Pablo José Manzanares Gallegos, Dulce María Gutiérrez Dávila, Luis Fernando Castillo Morales, Patricia Lizeth García Campa, Mariano González González, José Gerardo Varlamov, Elena V. Rodríguez Gutiérrez, René Fleseriu, Maria The Conundrum of Differentiating Cushing’s syndrome from Non-Neoplastic hypercortisolism: A Systematic Review and Meta-analysis |
| thumbnail | https://rediab.uanl.mx/themes/sandal5/images/online.png |
| title | The Conundrum of Differentiating Cushing’s syndrome from Non-Neoplastic hypercortisolism: A Systematic Review and Meta-analysis |
| title_full | The Conundrum of Differentiating Cushing’s syndrome from Non-Neoplastic hypercortisolism: A Systematic Review and Meta-analysis |
| title_fullStr | The Conundrum of Differentiating Cushing’s syndrome from Non-Neoplastic hypercortisolism: A Systematic Review and Meta-analysis |
| title_full_unstemmed | The Conundrum of Differentiating Cushing’s syndrome from Non-Neoplastic hypercortisolism: A Systematic Review and Meta-analysis |
| title_short | The Conundrum of Differentiating Cushing’s syndrome from Non-Neoplastic hypercortisolism: A Systematic Review and Meta-analysis |
| title_sort | conundrum of differentiating cushing s syndrome from non neoplastic hypercortisolism a systematic review and meta analysis |
| topic | RC Medicina Interna, Psiquiatría, Neurología |
| url | http://eprints.uanl.mx/27512/7/27512X.pdf |
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