Diagnostic tests for Cushing's syndrome differ from published guidelines: Data from ERCUSYN

Elena Valassi, Holger Franz, Thierry Brue, Richard A. Feelders, Romana Netea-Maier, Stylianos Tsagarakis, Susan M. Webb, Maria Yaneva, Martin Reincke, Michael Droste, Irina Komerdus, Dominique Maiter, Darko Kastelan, Philippe Chanson, Marija Pfeifer, Christian J. Strasburger, Miklós Tóth, Olivier Chabre, Antoine Tabarin, Michal KrsekCarmen Fajardo, Marek Bolanowski, Alicia Santos, John A.H. Wass, Peter J. Trainer, A. Ambrogio, G. Aranda, M. Arosio, M. Balomenaki, P. Beck-Peccoz, C. Berr-Kirmair, J. Bollerslev, D. Carvalho, F. Cavagnini, E. Christ, F. Demtröder, J. Denes, C. Dimopoulou, A. Dreval, T. Dusek, E. Erdinc, J. A. Evang, J. Fazel, S. Fica, E. Ghigo, M. Goth, Y. Greenman, V. Greisa, I. Halperin, F. A. Hanzu, A. Hermus, G. Johannsson, P. Kamenicky, A. Kasperlik-Zaluska, J. Kirchner, I. Kraljevic, A. Kruszynska, I. Lambrescu, S. Lang, A. Luger, N. Marpole, S. Martin, M. Martinie, O. Moros, J. Newell-Price, M. Orbetzova, I. Paiva, F. Pecori Giraldi, A. M. Pereira, J. Pickel, V. Pirags, O. Ragnarsson, A. D. Reghina, P. Riesgo, M. Roberts, S. Roerink, O. Roig, C. Rowan, P. Rudenko, M. A. Sahnoun, J. Salvador, H. A. Sigurjonsdottir, T. Skoric Polovina, R. Smith, B. Stachowska, G. Stalla, J. Tóke, E. Ubina, S. Vinay, M. Wagenmakers, S. Werner, J. Young, P. Zdunowski, K. Zopf, S. Zopp, I. Zosin

Research output: Contribution to journalReview article

Abstract

Objective: To evaluate which tests are performed to diagnose hypercortisolism in patients included in the European Registry on Cushing's syndrome (ERCUSYN), and to examine if their use differs from the current guidelines. Patients and methods: We analyzed data on the diagnostic tests performed in 1341 patients with Cushing's syndrome (CS) who have been entered into the ERCUSYN database between January 1, 2000 and January 31, 2016 from 57 centers in 26 European countries. Sixty-seven percent had pituitary-dependent CS (PIT-CS), 24% had adrenaldependent CS (ADR-CS), 6% had CS from an ectopic source (ECT-CS) and 3% were classified as having CS from other causes (OTH-CS). Results: Of the first-line tests, urinary free cortisol (UFC) test was performed in 78% of patients, overnight 1 mg dexamethasone suppression test (DST) in 60% and late-night salivary cortisol (LSaC) in 25%. Use of LSaC increased in the last five years as compared with previous years (P < 0.01). Use of HDDST was slightly more frequent in the last 5 years as compared with previous years (P < 0.05). Of the additional tests, late-night serum cortisol (LSeC) was measured in 62% and 48-h 2 mg/day low-dose dexamethasone suppression test (LDDST) in 33% of cases. ACTH was performed in 78% of patients. LSeC and overnight 1 mg DST supported the diagnosis of both PIT-CS and ADR-CS more frequently than UFC (P < 0.05).

Original languageEnglish
Pages (from-to)613-624
Number of pages12
JournalEuropean Journal of Endocrinology
Volume176
Issue number5
DOIs
Publication statusPublished - May 1 2017

Fingerprint

Cushing Syndrome
Routine Diagnostic Tests
Registries
Hydrocortisone
Guidelines
Dexamethasone
Pituitary ACTH Hypersecretion
Serum
Adrenocorticotropic Hormone
Databases

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Valassi, E., Franz, H., Brue, T., Feelders, R. A., Netea-Maier, R., Tsagarakis, S., ... Zosin, I. (2017). Diagnostic tests for Cushing's syndrome differ from published guidelines: Data from ERCUSYN. European Journal of Endocrinology, 176(5), 613-624. https://doi.org/10.1530/EJE-16-0967

Diagnostic tests for Cushing's syndrome differ from published guidelines : Data from ERCUSYN. / Valassi, Elena; Franz, Holger; Brue, Thierry; Feelders, Richard A.; Netea-Maier, Romana; Tsagarakis, Stylianos; Webb, Susan M.; Yaneva, Maria; Reincke, Martin; Droste, Michael; Komerdus, Irina; Maiter, Dominique; Kastelan, Darko; Chanson, Philippe; Pfeifer, Marija; Strasburger, Christian J.; Tóth, Miklós; Chabre, Olivier; Tabarin, Antoine; Krsek, Michal; Fajardo, Carmen; Bolanowski, Marek; Santos, Alicia; Wass, John A.H.; Trainer, Peter J.; Ambrogio, A.; Aranda, G.; Arosio, M.; Balomenaki, M.; Beck-Peccoz, P.; Berr-Kirmair, C.; Bollerslev, J.; Carvalho, D.; Cavagnini, F.; Christ, E.; Demtröder, F.; Denes, J.; Dimopoulou, C.; Dreval, A.; Dusek, T.; Erdinc, E.; Evang, J. A.; Fazel, J.; Fica, S.; Ghigo, E.; Goth, M.; Greenman, Y.; Greisa, V.; Halperin, I.; Hanzu, F. A.; Hermus, A.; Johannsson, G.; Kamenicky, P.; Kasperlik-Zaluska, A.; Kirchner, J.; Kraljevic, I.; Kruszynska, A.; Lambrescu, I.; Lang, S.; Luger, A.; Marpole, N.; Martin, S.; Martinie, M.; Moros, O.; Newell-Price, J.; Orbetzova, M.; Paiva, I.; Giraldi, F. Pecori; Pereira, A. M.; Pickel, J.; Pirags, V.; Ragnarsson, O.; Reghina, A. D.; Riesgo, P.; Roberts, M.; Roerink, S.; Roig, O.; Rowan, C.; Rudenko, P.; Sahnoun, M. A.; Salvador, J.; Sigurjonsdottir, H. A.; Polovina, T. Skoric; Smith, R.; Stachowska, B.; Stalla, G.; Tóke, J.; Ubina, E.; Vinay, S.; Wagenmakers, M.; Werner, S.; Young, J.; Zdunowski, P.; Zopf, K.; Zopp, S.; Zosin, I.

In: European Journal of Endocrinology, Vol. 176, No. 5, 01.05.2017, p. 613-624.

Research output: Contribution to journalReview article

Valassi, E, Franz, H, Brue, T, Feelders, RA, Netea-Maier, R, Tsagarakis, S, Webb, SM, Yaneva, M, Reincke, M, Droste, M, Komerdus, I, Maiter, D, Kastelan, D, Chanson, P, Pfeifer, M, Strasburger, CJ, Tóth, M, Chabre, O, Tabarin, A, Krsek, M, Fajardo, C, Bolanowski, M, Santos, A, Wass, JAH, Trainer, PJ, Ambrogio, A, Aranda, G, Arosio, M, Balomenaki, M, Beck-Peccoz, P, Berr-Kirmair, C, Bollerslev, J, Carvalho, D, Cavagnini, F, Christ, E, Demtröder, F, Denes, J, Dimopoulou, C, Dreval, A, Dusek, T, Erdinc, E, Evang, JA, Fazel, J, Fica, S, Ghigo, E, Goth, M, Greenman, Y, Greisa, V, Halperin, I, Hanzu, FA, Hermus, A, Johannsson, G, Kamenicky, P, Kasperlik-Zaluska, A, Kirchner, J, Kraljevic, I, Kruszynska, A, Lambrescu, I, Lang, S, Luger, A, Marpole, N, Martin, S, Martinie, M, Moros, O, Newell-Price, J, Orbetzova, M, Paiva, I, Giraldi, FP, Pereira, AM, Pickel, J, Pirags, V, Ragnarsson, O, Reghina, AD, Riesgo, P, Roberts, M, Roerink, S, Roig, O, Rowan, C, Rudenko, P, Sahnoun, MA, Salvador, J, Sigurjonsdottir, HA, Polovina, TS, Smith, R, Stachowska, B, Stalla, G, Tóke, J, Ubina, E, Vinay, S, Wagenmakers, M, Werner, S, Young, J, Zdunowski, P, Zopf, K, Zopp, S & Zosin, I 2017, 'Diagnostic tests for Cushing's syndrome differ from published guidelines: Data from ERCUSYN', European Journal of Endocrinology, vol. 176, no. 5, pp. 613-624. https://doi.org/10.1530/EJE-16-0967
Valassi E, Franz H, Brue T, Feelders RA, Netea-Maier R, Tsagarakis S et al. Diagnostic tests for Cushing's syndrome differ from published guidelines: Data from ERCUSYN. European Journal of Endocrinology. 2017 May 1;176(5):613-624. https://doi.org/10.1530/EJE-16-0967
Valassi, Elena ; Franz, Holger ; Brue, Thierry ; Feelders, Richard A. ; Netea-Maier, Romana ; Tsagarakis, Stylianos ; Webb, Susan M. ; Yaneva, Maria ; Reincke, Martin ; Droste, Michael ; Komerdus, Irina ; Maiter, Dominique ; Kastelan, Darko ; Chanson, Philippe ; Pfeifer, Marija ; Strasburger, Christian J. ; Tóth, Miklós ; Chabre, Olivier ; Tabarin, Antoine ; Krsek, Michal ; Fajardo, Carmen ; Bolanowski, Marek ; Santos, Alicia ; Wass, John A.H. ; Trainer, Peter J. ; Ambrogio, A. ; Aranda, G. ; Arosio, M. ; Balomenaki, M. ; Beck-Peccoz, P. ; Berr-Kirmair, C. ; Bollerslev, J. ; Carvalho, D. ; Cavagnini, F. ; Christ, E. ; Demtröder, F. ; Denes, J. ; Dimopoulou, C. ; Dreval, A. ; Dusek, T. ; Erdinc, E. ; Evang, J. A. ; Fazel, J. ; Fica, S. ; Ghigo, E. ; Goth, M. ; Greenman, Y. ; Greisa, V. ; Halperin, I. ; Hanzu, F. A. ; Hermus, A. ; Johannsson, G. ; Kamenicky, P. ; Kasperlik-Zaluska, A. ; Kirchner, J. ; Kraljevic, I. ; Kruszynska, A. ; Lambrescu, I. ; Lang, S. ; Luger, A. ; Marpole, N. ; Martin, S. ; Martinie, M. ; Moros, O. ; Newell-Price, J. ; Orbetzova, M. ; Paiva, I. ; Giraldi, F. Pecori ; Pereira, A. M. ; Pickel, J. ; Pirags, V. ; Ragnarsson, O. ; Reghina, A. D. ; Riesgo, P. ; Roberts, M. ; Roerink, S. ; Roig, O. ; Rowan, C. ; Rudenko, P. ; Sahnoun, M. A. ; Salvador, J. ; Sigurjonsdottir, H. A. ; Polovina, T. Skoric ; Smith, R. ; Stachowska, B. ; Stalla, G. ; Tóke, J. ; Ubina, E. ; Vinay, S. ; Wagenmakers, M. ; Werner, S. ; Young, J. ; Zdunowski, P. ; Zopf, K. ; Zopp, S. ; Zosin, I. / Diagnostic tests for Cushing's syndrome differ from published guidelines : Data from ERCUSYN. In: European Journal of Endocrinology. 2017 ; Vol. 176, No. 5. pp. 613-624.
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title = "Diagnostic tests for Cushing's syndrome differ from published guidelines: Data from ERCUSYN",
abstract = "Objective: To evaluate which tests are performed to diagnose hypercortisolism in patients included in the European Registry on Cushing's syndrome (ERCUSYN), and to examine if their use differs from the current guidelines. Patients and methods: We analyzed data on the diagnostic tests performed in 1341 patients with Cushing's syndrome (CS) who have been entered into the ERCUSYN database between January 1, 2000 and January 31, 2016 from 57 centers in 26 European countries. Sixty-seven percent had pituitary-dependent CS (PIT-CS), 24{\%} had adrenaldependent CS (ADR-CS), 6{\%} had CS from an ectopic source (ECT-CS) and 3{\%} were classified as having CS from other causes (OTH-CS). Results: Of the first-line tests, urinary free cortisol (UFC) test was performed in 78{\%} of patients, overnight 1 mg dexamethasone suppression test (DST) in 60{\%} and late-night salivary cortisol (LSaC) in 25{\%}. Use of LSaC increased in the last five years as compared with previous years (P < 0.01). Use of HDDST was slightly more frequent in the last 5 years as compared with previous years (P < 0.05). Of the additional tests, late-night serum cortisol (LSeC) was measured in 62{\%} and 48-h 2 mg/day low-dose dexamethasone suppression test (LDDST) in 33{\%} of cases. ACTH was performed in 78{\%} of patients. LSeC and overnight 1 mg DST supported the diagnosis of both PIT-CS and ADR-CS more frequently than UFC (P < 0.05).",
author = "Elena Valassi and Holger Franz and Thierry Brue and Feelders, {Richard A.} and Romana Netea-Maier and Stylianos Tsagarakis and Webb, {Susan M.} and Maria Yaneva and Martin Reincke and Michael Droste and Irina Komerdus and Dominique Maiter and Darko Kastelan and Philippe Chanson and Marija Pfeifer and Strasburger, {Christian J.} and Mikl{\'o}s T{\'o}th and Olivier Chabre and Antoine Tabarin and Michal Krsek and Carmen Fajardo and Marek Bolanowski and Alicia Santos and Wass, {John A.H.} and Trainer, {Peter J.} and A. Ambrogio and G. Aranda and M. Arosio and M. Balomenaki and P. Beck-Peccoz and C. Berr-Kirmair and J. Bollerslev and D. Carvalho and F. Cavagnini and E. Christ and F. Demtr{\"o}der and J. Denes and C. Dimopoulou and A. Dreval and T. Dusek and E. Erdinc and Evang, {J. A.} and J. Fazel and S. Fica and E. Ghigo and M. Goth and Y. Greenman and V. Greisa and I. Halperin and Hanzu, {F. A.} and A. Hermus and G. Johannsson and P. Kamenicky and A. Kasperlik-Zaluska and J. Kirchner and I. Kraljevic and A. Kruszynska and I. Lambrescu and S. Lang and A. Luger and N. Marpole and S. Martin and M. Martinie and O. Moros and J. Newell-Price and M. Orbetzova and I. Paiva and Giraldi, {F. Pecori} and Pereira, {A. M.} and J. Pickel and V. Pirags and O. Ragnarsson and Reghina, {A. D.} and P. Riesgo and M. Roberts and S. Roerink and O. Roig and C. Rowan and P. Rudenko and Sahnoun, {M. A.} and J. Salvador and Sigurjonsdottir, {H. A.} and Polovina, {T. Skoric} and R. Smith and B. Stachowska and G. Stalla and J. T{\'o}ke and E. Ubina and S. Vinay and M. Wagenmakers and S. Werner and J. Young and P. Zdunowski and K. Zopf and S. Zopp and I. Zosin",
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month = "5",
day = "1",
doi = "10.1530/EJE-16-0967",
language = "English",
volume = "176",
pages = "613--624",
journal = "European Journal of Endocrinology",
issn = "0804-4643",
publisher = "BioScientifica Ltd.",
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TY - JOUR

T1 - Diagnostic tests for Cushing's syndrome differ from published guidelines

T2 - Data from ERCUSYN

AU - Valassi, Elena

AU - Franz, Holger

AU - Brue, Thierry

AU - Feelders, Richard A.

AU - Netea-Maier, Romana

AU - Tsagarakis, Stylianos

AU - Webb, Susan M.

AU - Yaneva, Maria

AU - Reincke, Martin

AU - Droste, Michael

AU - Komerdus, Irina

AU - Maiter, Dominique

AU - Kastelan, Darko

AU - Chanson, Philippe

AU - Pfeifer, Marija

AU - Strasburger, Christian J.

AU - Tóth, Miklós

AU - Chabre, Olivier

AU - Tabarin, Antoine

AU - Krsek, Michal

AU - Fajardo, Carmen

AU - Bolanowski, Marek

AU - Santos, Alicia

AU - Wass, John A.H.

AU - Trainer, Peter J.

AU - Ambrogio, A.

AU - Aranda, G.

AU - Arosio, M.

AU - Balomenaki, M.

AU - Beck-Peccoz, P.

AU - Berr-Kirmair, C.

AU - Bollerslev, J.

AU - Carvalho, D.

AU - Cavagnini, F.

AU - Christ, E.

AU - Demtröder, F.

AU - Denes, J.

AU - Dimopoulou, C.

AU - Dreval, A.

AU - Dusek, T.

AU - Erdinc, E.

AU - Evang, J. A.

AU - Fazel, J.

AU - Fica, S.

AU - Ghigo, E.

AU - Goth, M.

AU - Greenman, Y.

AU - Greisa, V.

AU - Halperin, I.

AU - Hanzu, F. A.

AU - Hermus, A.

AU - Johannsson, G.

AU - Kamenicky, P.

AU - Kasperlik-Zaluska, A.

AU - Kirchner, J.

AU - Kraljevic, I.

AU - Kruszynska, A.

AU - Lambrescu, I.

AU - Lang, S.

AU - Luger, A.

AU - Marpole, N.

AU - Martin, S.

AU - Martinie, M.

AU - Moros, O.

AU - Newell-Price, J.

AU - Orbetzova, M.

AU - Paiva, I.

AU - Giraldi, F. Pecori

AU - Pereira, A. M.

AU - Pickel, J.

AU - Pirags, V.

AU - Ragnarsson, O.

AU - Reghina, A. D.

AU - Riesgo, P.

AU - Roberts, M.

AU - Roerink, S.

AU - Roig, O.

AU - Rowan, C.

AU - Rudenko, P.

AU - Sahnoun, M. A.

AU - Salvador, J.

AU - Sigurjonsdottir, H. A.

AU - Polovina, T. Skoric

AU - Smith, R.

AU - Stachowska, B.

AU - Stalla, G.

AU - Tóke, J.

AU - Ubina, E.

AU - Vinay, S.

AU - Wagenmakers, M.

AU - Werner, S.

AU - Young, J.

AU - Zdunowski, P.

AU - Zopf, K.

AU - Zopp, S.

AU - Zosin, I.

PY - 2017/5/1

Y1 - 2017/5/1

N2 - Objective: To evaluate which tests are performed to diagnose hypercortisolism in patients included in the European Registry on Cushing's syndrome (ERCUSYN), and to examine if their use differs from the current guidelines. Patients and methods: We analyzed data on the diagnostic tests performed in 1341 patients with Cushing's syndrome (CS) who have been entered into the ERCUSYN database between January 1, 2000 and January 31, 2016 from 57 centers in 26 European countries. Sixty-seven percent had pituitary-dependent CS (PIT-CS), 24% had adrenaldependent CS (ADR-CS), 6% had CS from an ectopic source (ECT-CS) and 3% were classified as having CS from other causes (OTH-CS). Results: Of the first-line tests, urinary free cortisol (UFC) test was performed in 78% of patients, overnight 1 mg dexamethasone suppression test (DST) in 60% and late-night salivary cortisol (LSaC) in 25%. Use of LSaC increased in the last five years as compared with previous years (P < 0.01). Use of HDDST was slightly more frequent in the last 5 years as compared with previous years (P < 0.05). Of the additional tests, late-night serum cortisol (LSeC) was measured in 62% and 48-h 2 mg/day low-dose dexamethasone suppression test (LDDST) in 33% of cases. ACTH was performed in 78% of patients. LSeC and overnight 1 mg DST supported the diagnosis of both PIT-CS and ADR-CS more frequently than UFC (P < 0.05).

AB - Objective: To evaluate which tests are performed to diagnose hypercortisolism in patients included in the European Registry on Cushing's syndrome (ERCUSYN), and to examine if their use differs from the current guidelines. Patients and methods: We analyzed data on the diagnostic tests performed in 1341 patients with Cushing's syndrome (CS) who have been entered into the ERCUSYN database between January 1, 2000 and January 31, 2016 from 57 centers in 26 European countries. Sixty-seven percent had pituitary-dependent CS (PIT-CS), 24% had adrenaldependent CS (ADR-CS), 6% had CS from an ectopic source (ECT-CS) and 3% were classified as having CS from other causes (OTH-CS). Results: Of the first-line tests, urinary free cortisol (UFC) test was performed in 78% of patients, overnight 1 mg dexamethasone suppression test (DST) in 60% and late-night salivary cortisol (LSaC) in 25%. Use of LSaC increased in the last five years as compared with previous years (P < 0.01). Use of HDDST was slightly more frequent in the last 5 years as compared with previous years (P < 0.05). Of the additional tests, late-night serum cortisol (LSeC) was measured in 62% and 48-h 2 mg/day low-dose dexamethasone suppression test (LDDST) in 33% of cases. ACTH was performed in 78% of patients. LSeC and overnight 1 mg DST supported the diagnosis of both PIT-CS and ADR-CS more frequently than UFC (P < 0.05).

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U2 - 10.1530/EJE-16-0967

DO - 10.1530/EJE-16-0967

M3 - Review article

C2 - 28377460

AN - SCOPUS:85017487373

VL - 176

SP - 613

EP - 624

JO - European Journal of Endocrinology

JF - European Journal of Endocrinology

SN - 0804-4643

IS - 5

ER -