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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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:
CreadorEmailORCID
Hinojosa Amaya, José Miguelmiguel.hinojosa398@uanl.edu.mxorcid.org/0000-0002-6015-797X
González Colmenero, Fernando Díazferdgc1412@gmail.comNO ESPECIFICADO
Alvarez Villalobos, Neri Alejandrovillalobos.neri@mayo.eduNO ESPECIFICADO
Salcido Montenegro, Alejandroalex.salcido.montenegro@gmail.comorcid.org/0000-0002-2487-0241
Quintanilla Sánchez, Carolinacarolina.qsg@gmail.comorcid.org/0000-0002-0595-6162
Moreno Peña, Pablo Josépjmp9926@gmail.comNO ESPECIFICADO
Manzanares Gallegos, Dulce Maríadulcemanzanares20@gmail.comNO ESPECIFICADO
Gutiérrez Dávila, Luis Fernandoluis.gtz00@gmail.comNO ESPECIFICADO
Castillo Morales, Patricia Lizeths.castillomg@gmail.comNO ESPECIFICADO
García Campa, Marianomarianogarciax@gmail.comNO ESPECIFICADO
González González, José Gerardogergonz@hotmail.comNO ESPECIFICADO
Varlamov, Elena V.varlamoe@ohsu.comNO ESPECIFICADO
Rodríguez Gutiérrez, Renérodriguezgutierrez.rene@mayo.eduorcid.org/0000-0002-3022-5302
Fleseriu, Mariafleseriu@ohsu.eduorcid.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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