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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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Tags: Endocrine Tag this Diagnosis.

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 SensitivitySpecificity Comments, Study
Urinary Free Cortisol Edit 94%94%

>270 nmol/24h

normal range: <80120 mcg/24 h or <220330 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 Edit
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 Edit 92%93%

<7.5mcg/dl

Study: Nat Clin Pract Endocrinol Metab. 2008 Jun;4(6):344-50. PMID: 18446140

Dexamethasone Suppression Test
Duplicate Edit
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 Edit 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 Edit
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 Edit
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 SensitivitySpecificity Comments, Study
Low-Dose Dexamethasone Suppression Test Edit 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 Edit Sensitivity = 100%

specificity not assessed

Study: Ann N Y Acad Sci. 2002 Sep;970:112-8. PMID: 12381546

Obesity Edit Sensitivity = 97%

specificity not assessed

Study: Ann N Y Acad Sci. 2002 Sep;970:112-8. PMID: 12381546

Plethora Edit Sensitivity = 94%

specificity not assessed

Study: Ann N Y Acad Sci. 2002 Sep;970:112-8. PMID: 12381546

Late-Night Plasma Cortisol Edit 93%20%

<1.8 mcg/dl

Study: Arq Bras Endocrinol Metabol. 2007 Nov;51(8):1191-8. PMID: 18209856

Round Face Edit Sensitivity = 88%

specificity not assessed

Study: Ann N Y Acad Sci. 2002 Sep;970:112-8. PMID: 12381546

Poorly Diagnostic Findings

Finding SensitivitySpecificity Comments, Study
Hirsuitism Edit Sensitivity = 81%

specificity not assessed

Study: Ann N Y Acad Sci. 2002 Sep;970:112-8. PMID: 12381546

Hypertension Edit Sensitivity = 74%

specificity not assessed

Study: Ann N Y Acad Sci. 2002 Sep;970:112-8. PMID: 12381546

Ecchymoses Edit Sensitivity = 62%

specificity not assessed

Study: Ann N Y Acad Sci. 2002 Sep;970:112-8. PMID: 12381546

Striae Edit Sensitivity = 56%

specificity not assessed

Study: Ann N Y Acad Sci. 2002 Sep;970:112-8. PMID: 12381546

Dorsal Fat Pad Edit Sensitivity = 54%

specificity not assessed

Study: Ann N Y Acad Sci. 2002 Sep;970:112-8. PMID: 12381546

Edema Edit Sensitivity = 50%

specificity not assessed

Study: Ann N Y Acad Sci. 2002 Sep;970:112-8. PMID: 12381546

Impaired Glucose Tolerance Edit Sensitivity = 50%

specificity not assessed

Study: Ann N Y Acad Sci. 2002 Sep;970:112-8. PMID: 12381546

Osteopenia or Fracture Edit Sensitivity = 50%

specificity not assessed

Study: Ann N Y Acad Sci. 2002 Sep;970:112-8. PMID: 12381546