Please use this identifier to cite or link to this item: http://hdl.handle.net/10553/52055
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dc.contributor.authorPuig, Jaumeen_US
dc.contributor.authorWägner, Annaen_US
dc.contributor.authorCaballero, Aguedaen_US
dc.contributor.authorRodríguez-Espinosa, Joséen_US
dc.contributor.authorWebb, Susan Maryen_US
dc.date.accessioned2018-11-25T17:03:52Z-
dc.date.available2018-11-25T17:03:52Z-
dc.date.issued1999en_US
dc.identifier.issn1386-341Xen_US
dc.identifier.urihttp://hdl.handle.net/10553/52055-
dc.description.abstractAim: 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.en_US
dc.languageengen_US
dc.relation.ispartofPituitaryen_US
dc.sourcePituitary[ISSN 1386-341X],v. 1, p. 125-132 (Junio 1999)en_US
dc.subject32 Ciencias médicasen_US
dc.subject3205 Medicina internaen_US
dc.subject320502 Endocrinologíaen_US
dc.subject.otherCushing's syndromeen_US
dc.subject.otherDiagnosisen_US
dc.subject.otherCost-effectiveen_US
dc.titleCost-effectiveness and accuracy of the tests used in the differential diagnosis of Cushing's syndromeen_US
dc.typeinfo:eu-repo/semantics/articleen_US
dc.typeArticleen_US
dc.identifier.doi10.1023/A:1009936622150en_US
dc.identifier.scopus0033289470-
dc.contributor.authorscopusid57197326503-
dc.contributor.authorscopusid7401456520-
dc.contributor.authorscopusid55187931000-
dc.contributor.authorscopusid7005699402-
dc.contributor.authorscopusid7402907929-
dc.description.lastpage132en_US
dc.description.firstpage125en_US
dc.relation.volume1en_US
dc.investigacionCiencias de la Saluden_US
dc.type2Artículoen_US
dc.description.numberofpages8en_US
dc.utils.revisionen_US
dc.date.coverdateJunio 1999en_US
dc.identifier.ulpgcen_US
dc.contributor.buulpgcBU-MEDen_US
dc.description.scieSCIE-
item.grantfulltextnone-
item.fulltextSin texto completo-
crisitem.author.deptGIR IUIBS: Diabetes y endocrinología aplicada-
crisitem.author.deptIU de Investigaciones Biomédicas y Sanitarias-
crisitem.author.deptDepartamento de Ciencias Médicas y Quirúrgicas-
crisitem.author.orcid0000-0002-7663-9308-
crisitem.author.parentorgIU de Investigaciones Biomédicas y Sanitarias-
crisitem.author.fullNameWägner, Anna Maria Claudia-
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