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Good Positive and Negative Likelihood Ratios

Good Negative Likelihood Ratio

Poorly Diagnostic Findings

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.

Good Positive and Negative Likelihood Ratios

Finding +LR-LR Comments, Study
Dexamethasone Suppression Test
Duplicate Edit
9.70

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 Edit 30

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 Edit 15.70.1

>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 Edit
15.50.1

salivary cortisol after 1mg dex < 390ng/dl

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

Late-Night Salivary Cortisol Edit 13.10.1

<7.5mcg/dl

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

Dexamethasone Suppression Test
Duplicate Edit
11.50.1

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 Edit 9.70.1

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 Edit
70.1

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

Finding +LR-LR Comments, Study
Late-Night Plasma Cortisol Edit 1.20.4

<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 Edit 1.40.9

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 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

Round Face Edit Sensitivity = 88%

specificity not assessed

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

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