The Conundrum of Differentiating Cushing’s syndrome from Non-Neoplastic hypercortisolism: A Systematic Review and Meta-analysis

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)

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Resumen

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

Tipo de elemento:	Otro
Materias:	R Medicina > RC Medicina Interna, Psiquiatría, Neurología
Divisiones:	Medicina
Usuario depositante:	Dr. José Miguel Hinojosa Amaya
Creadores:	Creador Email ORCID Hinojosa Amaya, José Miguel miguel.hinojosa398@uanl.edu.mx orcid.org/0000-0002-6015-797X González Colmenero, Fernando Díaz ferdgc1412@gmail.com NO ESPECIFICADO Alvarez Villalobos, Neri Alejandro villalobos.neri@mayo.edu NO ESPECIFICADO Salcido Montenegro, Alejandro alex.salcido.montenegro@gmail.com orcid.org/0000-0002-2487-0241 Quintanilla Sánchez, Carolina carolina.qsg@gmail.com orcid.org/0000-0002-0595-6162 Moreno Peña, Pablo José pjmp9926@gmail.com NO ESPECIFICADO Manzanares Gallegos, Dulce María dulcemanzanares20@gmail.com NO ESPECIFICADO Gutiérrez Dávila, Luis Fernando luis.gtz00@gmail.com NO ESPECIFICADO Castillo Morales, Patricia Lizeth s.castillomg@gmail.com NO ESPECIFICADO García Campa, Mariano marianogarciax@gmail.com NO ESPECIFICADO González González, José Gerardo gergonz@hotmail.com NO ESPECIFICADO Varlamov, Elena V. varlamoe@ohsu.com NO ESPECIFICADO Rodríguez Gutiérrez, René rodriguezgutierrez.rene@mayo.edu orcid.org/0000-0002-3022-5302 Fleseriu, Maria fleseriu@ohsu.edu orcid.org/0000-0001-9284-6289
Fecha del depósito:	14 Jun 2024 16:47
Última modificación:	24 Jun 2024 14:56
URI:	http://eprints.uanl.mx/id/eprint/27512

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• Supplementary Material: Diagnostic Tests for Differentiation between Cushing´s Syndrome and Non-Neoplastic Hypercortisolism: A Systematic Review and Meta-analysis. (deposited 25 Sep 2023 22:07)
  • The Conundrum of Differentiating Cushing’s syndrome from Non-Neoplastic hypercortisolism: A Systematic Review and Meta-analysis. (deposited 14 Jun 2024 16:47) [Currently Displayed]

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