Please use this identifier to cite or link to this item: http://hdl.handle.net/10553/52055
Title: Cost-effectiveness and accuracy of the tests used in the differential diagnosis of Cushing's syndrome
Authors: Puig, Jaume
Wägner, Anna 
Caballero, Agueda
Rodríguez-Espinosa, José
Webb, Susan Mary
UNESCO Clasification: 32 Ciencias médicas
3205 Medicina interna
320502 Endocrinología
Keywords: Cushing's syndrome
Diagnosis
Cost-effective
Issue Date: 1999
Journal: Pituitary 
Abstract: Aim: Establish the minimal biochemical and radiological examinations necessary and their cost-effectiveness to accurately diagnose the etiology of Cushing's syndrome (CS). Material and Methods: In 71 patients with CS followed between 1982 and 1997 biochemical studies (basal ACTH, 8mg dexamethasone suppression test -HDST-, metyrapone stimulation test -MST-, or inferior petrosal sinus catheterization sinus catheterization -IPSC-) and radiological investigations (abdominal CT scan, pituitary CT scan or MRI) were performed. Once pathology confirmed the diagnosis (48 pituitary Cushing's disease-CD, 17 adrenal neoplasms, 2 bilateral macronodular hyperplasia -BMH-, and 4 ectopic ACTH syndrome -ES-), the sensitivity, specificity, positive and negative predictive value of the different studies was calculated to establish the most accurate and cost-effective diagnostic protocol. Results: In ACTH-independent CS (ACTH ≤ 9 pg/ml; normal 9 to 54) a unilateral tumor was identified on abdominal CT scanning in 17, and BMH in 1; the other BMH had detectable ACTH (43.2 pg/ml). In ACTH-dependent CS, ACTH was > 9 pg/ml and IPSC (performed in 22) correctly identified 20 patients with CD and differentiated them from 2 with an ES (100 % specificity and sensitivity). Pituitary MRI or CT did not disclose an adenoma in 41.7% of patients with CD, and was reported to exhibit a microadenoma in 2 of the 4 patients with ES. HDST and MST were of no additional use in the differentiation between CD and ES. Conclusions: Once CS is diagnosed low ACTH and an abdominal CT scan correctly identified all patients of adrenal origin. In ACTH-dependent CS IPSC was the best predictive test to differentiate CD from ES. BMH may behave as ACTH-dependent or independent. The other biochemical and radiological studies performed are not cost-effective and may even be misleading, and should not be routinely performed.
URI: http://hdl.handle.net/10553/52055
ISSN: 1386-341X
DOI: 10.1023/A:1009936622150
Source: Pituitary[ISSN 1386-341X],v. 1, p. 125-132 (Junio 1999)
Appears in Collections:Artículos
Show full item record

SCOPUSTM   
Citations

4
checked on Mar 24, 2024

Page view(s)

43
checked on Feb 17, 2024

Google ScholarTM

Check

Altmetric


Share



Export metadata



Items in accedaCRIS are protected by copyright, with all rights reserved, unless otherwise indicated.