Cushing's Syndrome: Sensitivity and Specificity

Introduction: i.e. hypercortisolemia. Can be primary (from an adrenal tumor or other malignancy) or secondary (from a pituitary tumor, called Cushing's Disease).

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The sensitivity and specificity of findings for Cushing's Syndrome are listed below. See the left navigation bar to change the display.

Sensitive and Specific Findings

Finding	Sensitivity	Specificity	Comments, Study
Urinary Free Cortisol	94%	94%	>270 nmol/24h normal range: <80–120 mcg/24 h or <220–330 nmol/ 24h (RIA); <50 mcg/24 h or <138 nmol/24h (HPLC). Study: J Endocrinol Invest. 1999 Apr;22(4):241-9. PMID: 10342356 Arq Bras Endocrinol Metabol. 2007 Nov;51(8):1191-8. PMID: 18209856
Dexamethasone Suppression Test Duplicate	93%	94%	salivary cortisol after 1mg dex < 390ng/dl Study: Arq Bras Endocrinol Metabol. 2007 Nov;51(8):1191-8. PMID: 18209856
Late-Night Salivary Cortisol	92%	93%	<7.5mcg/dl Study: Nat Clin Pract Endocrinol Metab. 2008 Jun;4(6):344-50. PMID: 18446140
Dexamethasone Suppression Test Duplicate	92%	92%	plasma cortisol after 2mg dex over 2 days < 1.8mcg/dl Study: Arq Bras Endocrinol Metabol. 2007 Nov;51(8):1191-8. PMID: 18209856
Desmopressin Stimulation Test	87%	91%	after DDAVP dose, plasma ACTH increases > 27pg/ml or 6pmol/L Study: Arq Bras Endocrinol Metabol. 2007 Nov;51(8):1191-8. PMID: 18209856
Dexamethasone Suppression Test Duplicate	97%	90%	urinary free cortisol after 2mg dex over 2 days < 10mcg / 24 hr Study: Arq Bras Endocrinol Metabol. 2007 Nov;51(8):1191-8. PMID: 18209856
Dexamethasone Suppression Test Duplicate	91%	87%	plasma cortisol after 1mg dex < 1.8mcg/dl Study: Arq Bras Endocrinol Metabol. 2007 Nov;51(8):1191-8. PMID: 18209856

Sensitive Findings

Finding	Sensitivity	Specificity	Comments, Study
Low-Dose Dexamethasone Suppression Test	100%	67%	plasma cortisol < 1.4mcg/dl after low-dose DST or CRH Study: Arq Bras Endocrinol Metabol. 2007 Nov;51(8):1191-8. PMID: 18209856
Decreased Libido	Sensitivity = 100%		specificity not assessed Study: Ann N Y Acad Sci. 2002 Sep;970:112-8. PMID: 12381546
Obesity	Sensitivity = 97%		specificity not assessed Study: Ann N Y Acad Sci. 2002 Sep;970:112-8. PMID: 12381546
Plethora	Sensitivity = 94%		specificity not assessed Study: Ann N Y Acad Sci. 2002 Sep;970:112-8. PMID: 12381546
Late-Night Plasma Cortisol	93%	20%	<1.8 mcg/dl Study: Arq Bras Endocrinol Metabol. 2007 Nov;51(8):1191-8. PMID: 18209856
Round Face	Sensitivity = 88%		specificity not assessed Study: Ann N Y Acad Sci. 2002 Sep;970:112-8. PMID: 12381546

Poorly Diagnostic Findings

Finding	Sensitivity	Specificity	Comments, Study
DHEAS	30%	79%	With gold standard of DST >1.8 mcg/dl Study: Araujo-Castro, M., García Cano, A., Jiménez Mendiguchía, L. et al. Diagnostic accuracy of the different hormonal tests used for the diagnosis of autonomous cortisol secretion. Sci Rep 11, 20539 (2021). https://doi.org/10.1038/s41598-021-00011-4 https://www.nature.com/articles/s41598-021-00011-4
Hirsuitism	Sensitivity = 81%		specificity not assessed Study: Ann N Y Acad Sci. 2002 Sep;970:112-8. PMID: 12381546
Hypertension	Sensitivity = 74%		specificity not assessed Study: Ann N Y Acad Sci. 2002 Sep;970:112-8. PMID: 12381546
Ecchymoses	Sensitivity = 62%		specificity not assessed Study: Ann N Y Acad Sci. 2002 Sep;970:112-8. PMID: 12381546
Striae	Sensitivity = 56%		specificity not assessed Study: Ann N Y Acad Sci. 2002 Sep;970:112-8. PMID: 12381546
Dorsal Fat Pad	Sensitivity = 54%		specificity not assessed Study: Ann N Y Acad Sci. 2002 Sep;970:112-8. PMID: 12381546
Edema	Sensitivity = 50%		specificity not assessed Study: Ann N Y Acad Sci. 2002 Sep;970:112-8. PMID: 12381546
Impaired Glucose Tolerance	Sensitivity = 50%		specificity not assessed Study: Ann N Y Acad Sci. 2002 Sep;970:112-8. PMID: 12381546
Osteopenia or Fracture	Sensitivity = 50%		specificity not assessed Study: Ann N Y Acad Sci. 2002 Sep;970:112-8. PMID: 12381546