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Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Copyright © 2015 Korean Endocrine Society
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
CONFLICTS OF INTEREST: No potential conflict of interest relevant to this article was reported.
Patient no. | Sex | Age, yr | ACTH, pmol/L | HDST, % | Pituitary mass, mma | Adrenal mass, mma | |
---|---|---|---|---|---|---|---|
Serum cortisol | UFC | ||||||
1 | F | 69 | 38.3 | 99 | 99 | 10 | 10 |
2 | M | 66 | 3.5 | 89 | 97 | 5 | 10 |
3 | F | 73 | 22.2 | 90 | - | 5 | 10 |
Characteristic | Adrenal Cushing syndrome (n=57) | Cushing disease (n=35) | P value |
---|---|---|---|
Age at diagnosis, yr | 40 (31-54) | 40 (28-54) | 0.834 |
Female sex | 51 (89.5) | 28 (80.0) | 0.230 |
Body mass index, kg/m2 | 24.1 (21.6-27.0) | 23.6 (22.2-26.4) | 0.816 |
24-Hour UFC, nmol/day | 1,535 (1,004-3,022) | 1,199 (611-1,961) | 0.136 |
Serum cortisol, nmol/L | 499 (417-624) | 593 (397-712) | <0.001 |
ACTH, pmol/L | 3.1 (0.2-4.7) | 22.2 (12.1-29.9) | <0.001 |
DHEA-S, nmol/L | 677 (453-1,982) | 6,321 (3,610-8,850) | 0.001 |
Serum cortisol after LDST, nmol/L | 535 (430-601) | 290 (212-444) | 0.001 |
UFC after LDST, nmol/day | 1,311 (806-2,324) | 312 (146-624) | 0.001 |
Percentage suppression of serum cortisol after HDST, % | -0.7 (-13.3 to 17.5) | 88.5 (62.6-92.8) | <0.001 |
Percentage suppression of UFC after HDST, % | -3.1 (-78.2 to 24.0) | 94.4 (88.9-97.4) | <0.001 |
Patients with repeated ACTH measurement | 29 (50.9) | 18 (51.4) | 0.959 |
Mass size (adrenal or pituitary), mm | 18.5 (10.0-30.0) | 2.2 (0.1-5.0) | |
Patients with adrenal carcinoma | 1 (1.8) | - | |
Patients with pituitary adenoma of >10 mm | - | 3 (8.6) |
Characteristic | Suppressed ACTH (n=21) | Normal/high ACTH (n=36) | P value |
---|---|---|---|
Age at diagnosis, yr | 39 (32-54) | 42 (30-56) | 0.785 |
Female sex | 20 (95.2) | 31 (86.1) | 0.397 |
Body mass index, kg/m2 | 22.8 (20.7-27.1) | 24.1 (22.2-27.1) | 0.457 |
Adrenal mass size, mm | 30.0 (25.0-33.5) | 30.0 (25.0-34.8) | 0.784 |
24-Hour UFC, nmol/day | 1,120 (639-1,997) | 1,348 (593-1,886) | 0.832 |
Serum cortisol, nmol/L | 505 (436-668) | 499 (414-624) | 0.841 |
ACTH, pmol/L | 1.98 (2.11-2.18) | 4.44 (3.37-6.45) | <0.001 |
DHEA-S, nmol/L | 478 (236-570) | 1,048 (627-2,589) | 0.017 |
Serum cortisol after LDST, nmol/L | 535 (430-706) | 532 (372-582) | 0.571 |
UFC after LDST, nmol/day | 1,018 (847-2,672) | 1,098 (599-2,139) | 0.415 |
Percentage suppression of serum cortisol after HDST, % | 4.6 (-17.9 to 18.8) | -4.2 (-13.2 to 14.9) | 0.580 |
Percentage suppression of UFC after HDST, % | -2.2 (-66.1 to 16.4) | -7.3 (-91.1 to 24.7) | 0.878 |
Parameter | Cut-off value | AUC | 95% CI | Sensitivity, % | Specificity, % | PPV, % | NPV, % |
---|---|---|---|---|---|---|---|
ACTH, pmol/L | 5.3 | 0.954 | 0.889-0.987 | 84 | 94 | 96 | 79 |
DHEA-S, nmol/L | 2,464 | 0.810 | 0.693-0.936 | 86 | 85 | 92 | 73 |
Suppression of serum cortisol, % | -33.3 | 0.950 | 0.877-0.986 | 96 | 91 | 94 | 94 |
Suppression of UFC, % | -61.6 | 0.997 | 0.949-1.000 | 98 | 94 | 96 | 97 |
Patient no. | Sex | Age, yr | ACTH, pmol/L | HDST, % | Pituitary mass, mma | Adrenal mass, mma | |
---|---|---|---|---|---|---|---|
Serum cortisol | UFC | ||||||
1 | F | 69 | 38.3 | 99 | 99 | 10 | 10 |
2 | M | 66 | 3.5 | 89 | 97 | 5 | 10 |
3 | F | 73 | 22.2 | 90 | - | 5 | 10 |
Patient no. | Sex | Age, yr | ACTH, pmol/L | HDST, % | DHEA-S, nmol/L | Adrenal mass, mma | Pituitary mass, mma | |
---|---|---|---|---|---|---|---|---|
Serum cortisol | UFC | |||||||
1 | F | 24 | 8.4 | 29.0 | 14 | 665 | 37 | 4 |
2 | F | 33 | 3.5 | 19.0 | -152 | 510 | 27 | 7 |
3 | F | 21 | 8.4 | -29.0 | 10 | 8,717 | 10 | 4 |
4 | F | 27 | 2.0 | -64.0 | -467 | 185 | 27 | 3 |
5 | F | 51 | 4.8 | -111.0 | 11 | - | 32 | 4 |
6 | M | 40 | 5.4 | -1.3 | -10 | 1,878 | 30 | 3 |
7 | F | 40 | 4.4 | - | - | - | 10 | 2 |
8 | M | 53 | 1.8 | - | -17 | 2,464 | 10 | 3 |
9 | M | 57 | 3.7 | 6.7 | -36 | - | 20 | 5 |
Values are expressed as median (interquartile range) or number (%). UFC, urinary free cortisol; ACTH, adrenocorticotropic hormone; DHEA-S, dehydroepiandrosterone sulfate; LDST, low-dose dexamethasone suppression test; HDST, high-dose dexamethasone suppression test.
Values are expressed as median (interquartile range) or number (%). ACTH, adrenocorticotropic hormone; UFC, urinary free cortisol; DHEA-S, dehydroepiandrosterone sulfate; LDST, low-dose dexamethasone suppression test; HDST, high-dose dexamethasone suppression test.
AUC, area under the curve; CI, confidence interval; PPV, positive predictive value; NPV, negative predictive value; ACTH, adrenocorticotropic hormone; DHEA-S, dehydroepiandrosterone sulfate; UFC, urine free cortisol.
In the HDST, % indicates percentage suppression of serum cortisol and UFC after HDST. ACTH, adrenocorticotropic hormone; HDST, high-dose dexamethasone suppression test; UFC, urine free cortisol. aLongest diameter of mass.
In the HDST, % indicates percentage suppression of serum cortisol and UFC after HDST. ACTH, adrenocorticotropic hormone; HDST, high-dose dexamethasone suppression test; UFC, urine free cortisol; DHEA-S, dehydroepiandrosterone sulfate. aLongest diameter of mass.