Differences in clinical, hormonal and radiological profile between Cushing's disease and ectopic Cushing's syndrome. Series of 37 cases

IF 2.9 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Annales d'endocrinologie Pub Date : 2025-06-19 DOI:10.1016/j.ando.2025.101802

Carmen Gándara Gutiérrez , Mario Alfredo Saavedra Vásquez , Eider Pascual-Corrales , Víctor Rodríguez Berrocal , Manuel Luque-Ramírez , Marta Araujo-Castro

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引用次数: 0

Abstract

Introduction

ACTH-dependent Cushing's syndrome (CS) is a diagnostic challenge. Clinical variability and difficult interpretation of diagnostic tests delay diagnosis and increase morbidity.

Objective

To describe clinical, biochemical and radiological differences in patients with ACTH-dependent CS, with the aim of determining the variables that may help to non-invasively differentiate between Cushing's disease (CD) and ectopic CS (ECS).

Methods

A retrospective study included patients with ACTH-dependent CS followed at the Ramón y Cajal University Hospital between 2018 and 2023.

Results

Twenty-eight patients with CD and 9 with ECS were included. Urinary free cortisol (UFC) levels presented an area under the ROC curve (AUC) of 0.812 (95% CI, 0.607–1.000) to differentiate between the two entities. UFC > 4.2 times the upper limit of normal showed 62.5% sensitivity and 90.9% specificity for diagnosis of ECS. The differential diagnostic accuracy of potassium level between ECS and CD was 82% (95% CI, 0.598–1.000). The combination of UFC and potassium values increased diagnostic accuracy to 85% (95% CI, 0.586–1.000). 55.6% of patients with ECS presented metabolic alkalosis, compared to 2.8% of those with CD (P = 0.001). Pituitary adenoma size presented an AUC of 0.844 (95% CI, 0.59–1.000) for diagnosis of CD. Size ≥ 4.5 mm presented 93.8% sensitivity and 50% specificity for the diagnosis of CD.

Conclusions

UFC, hypokalemia, metabolic alkalosis and pituitary adenoma size are the non-invasive parameters most accurately differentiating between CD and ECS.

查看原文本刊更多论文

库欣病与异位库欣综合征在临床、激素和放射学方面的差异。37例。

acth依赖性库欣综合征（CS）是一个诊断挑战。临床变异性和诊断试验的难以解释延误了诊断并增加了发病率。目的：描述acth依赖性CS患者的临床、生化和影像学差异，目的是确定可能有助于无创区分库欣病（CD）和异位CS （ECS）的变量。方法：回顾性研究纳入了2018年至2023年在Ramón y Cajal大学医院随访的acth依赖性CS患者。结果：共纳入28例CD患者和9例ECS患者。尿游离皮质醇（UFC）水平的ROC曲线下面积（AUC）为0.812 (95% CI, 0.607-1.000)，以区分两个实体。UFC >为正常上限的4.2倍，诊断ECS的敏感性为62.5%，特异性为90.9%。ECS和CD之间钾水平的鉴别诊断准确率为82% （95% CI, 0.598-1.000）。UFC和钾值的结合将诊断准确率提高到85% （95% CI, 0.586-1.000）。55.6%的ECS患者出现代谢性碱中毒，而CD患者为2.8% （p= 0.001）。垂体腺瘤大小诊断CD的AUC为0.844 (95% CI, 0.59-1.000)，尺寸≥4.5 mm诊断CD的敏感性为93.8%，特异性为50%。结论：UFC、低钾血症、代谢性碱中毒和腺瘤大小是鉴别CD和ECS最准确的非侵入性参数。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annales d'endocrinologie 医学-内分泌学与代谢

CiteScore

4.40

自引率

6.50%

发文量

311

审稿时长

50 days

期刊介绍： The Annales d''Endocrinologie, mouthpiece of the French Society of Endocrinology (SFE), publishes reviews, articles and case reports coming from clinical, therapeutic and fundamental research in endocrinology and metabolic diseases. Every year, it carries a position paper by a work-group of French-language endocrinologists, on an endocrine pathology chosen by the Society''s Scientific Committee. The journal is also the organ of the Society''s annual Congress, publishing a summary of the symposia, presentations and posters. "Les Must de l''Endocrinologie" is a special booklet brought out for the Congress, with summary articles that are always very well received. And finally, we publish the high-level instructional courses delivered during the Henri-Pierre Klotz International Endocrinology Days. The Annales is a window on the world, keeping alert clinicians up to date on what is going on in diagnosis and treatment in all the areas of our specialty.