Cushing's Syndrome: Likelihood Ratios

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 likelihood ratios of findings for Cushing's Syndrome are listed below. See the left navigation bar to change the display.

Pre-Test Probability (Prevalence): %.	Post-Test Probability (Predictive Value): %.	Switch to display mode.
Note that calculating probabilities from more than one** finding is inherently inaccurate because findings are not independent. (For example, using two positive findings that share a common pathogenesis is likely to overestimate the true probability.)

Good Negative Likelihood Ratio
Finding	Result	+LR	-LR
[ + ] Late-Night Plasma Cortisol	+ 0 -	1.2	0.4
<1.8 mcg/dl Study: Arq Bras Endocrinol Metabol. 2007 Nov;51(8):1191-8. PMID: 18209856

Poorly Diagnostic Findings
Finding	Result	+LR	-LR
[ + ] DHEAS	+ 0 -	1.4	0.9
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
[ + ] 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
[ + ] Round Face		Sensitivity = 88%
specificity not assessed Study: Ann N Y Acad Sci. 2002 Sep;970:112-8. PMID: 12381546
[ + ] 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

Good Positive and Negative Likelihood Ratios
Finding	Result	+LR	-LR
[ + ] Dexamethasone Suppression Test	+ 0 -	9.7	0
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
[ + ] Low-Dose Dexamethasone Suppression Test	+ 0 -	3	0
plasma cortisol < 1.4mcg/dl after low-dose DST or CRH Study: Arq Bras Endocrinol Metabol. 2007 Nov;51(8):1191-8. PMID: 18209856
[ + ] Urinary Free Cortisol	+ 0 -	15.7	0.1
>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	+ 0 -	15.5	0.1
salivary cortisol after 1mg dex < 390ng/dl Study: Arq Bras Endocrinol Metabol. 2007 Nov;51(8):1191-8. PMID: 18209856
[ + ] Late-Night Salivary Cortisol	+ 0 -	13.1	0.1
<7.5mcg/dl Study: Nat Clin Pract Endocrinol Metab. 2008 Jun;4(6):344-50. PMID: 18446140
[ + ] Dexamethasone Suppression Test	+ 0 -	11.5	0.1
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	+ 0 -	9.7	0.1
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	+ 0 -	7	0.1
plasma cortisol after 1mg dex < 1.8mcg/dl Study: Arq Bras Endocrinol Metabol. 2007 Nov;51(8):1191-8. PMID: 18209856