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

Good Positive and Negative Likelihood Ratios

Finding	+LR	-LR	Comments, Study
Dexamethasone Suppression Test Duplicate	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	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	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 Duplicate	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	13.1	0.1	<7.5mcg/dl Study: Nat Clin Pract Endocrinol Metab. 2008 Jun;4(6):344-50. PMID: 18446140
Dexamethasone Suppression Test Duplicate	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	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 Duplicate	7	0.1	plasma cortisol after 1mg dex < 1.8mcg/dl Study: Arq Bras Endocrinol Metabol. 2007 Nov;51(8):1191-8. PMID: 18209856

Good Negative Likelihood Ratio

Late-Night Plasma Cortisol

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	+LR	-LR	Comments, Study
DHEAS	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