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.

Endocrine

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

Fluid Test

Hypertension

Sensitivity = 74%

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

Physical Exam

Hypertension

Sensitivity = 74%

specificity not assessed

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

Toxic

Hypertension

Sensitivity = 74%

specificity not assessed

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

Untagged

Finding	Sensitivity	Specificity	Comments, Study
Decreased Libido	Sensitivity = 100%		specificity not assessed Study: Ann N Y Acad Sci. 2002 Sep;970:112-8. PMID: 12381546
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	91%	87%	plasma cortisol after 1mg dex < 1.8mcg/dl Study: Arq Bras Endocrinol Metabol. 2007 Nov;51(8):1191-8. PMID: 18209856
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
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
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
Dorsal Fat Pad	Sensitivity = 54%		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
Edema	Sensitivity = 50%		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
Impaired Glucose Tolerance	Sensitivity = 50%		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
Late-Night Salivary Cortisol	92%	93%	<7.5mcg/dl Study: Nat Clin Pract Endocrinol Metab. 2008 Jun;4(6):344-50. PMID: 18446140
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
Obesity	Sensitivity = 97%		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
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
Striae	Sensitivity = 56%		specificity not assessed Study: Ann N Y Acad Sci. 2002 Sep;970:112-8. PMID: 12381546
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