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Endocrine Abstracts (2017) 49 EP899 | DOI: 10.1530/endoabs.49.EP899

1Division of Endocrinology, Hospital das Clinicas, Federal University of Pernambuco, Recife (Pernambuco), Brazil; 2Endocrine Research Center of Pernambuco, Recife (Pernambuco), Brazil.


Patients and methods: We retrospectively analysed the clinical and biochemical characteristics of a cohort of 150 patients with endogenous Cushing’s syndrome (CS). Cushing’s disease (CD) accounted for 61.3% of cases (n=92), ectopic ACTH secretion (EAS) 7.3% (n=11), and adrenal diseases 31.3% (n=47). Among CD cases, there were 19 macroadenomas (20.6%), a female predominance (60.5%) and a median age of 33 years old (range 14–55). Bronchial carcinoid was the most frequent cause of EAS (n=7). When biochemical and clinical features were compared in cases of CD and EAS, the only significant difference was the higher frequency of hypocalemia in EAS (80% vs. 15%; P<0.001). Concerning screening tests, the sensitivities of overnight 1 mg-DST (cut-off, 1.8 μg/dl (50 mmol/l)), UFC and late night salivary cortisol (LNSC) were 94%, 90% and 96%, respectively. The combination of two of these tests yielded a sensitivity of 98% ACTH levels were normal (42%) or elevated (58%) among patients with CD; they were above the normal range in all EAS cases and <10 pg/ml in all patients with adrenal disorders. Regarding dynamic tests, HDDST had a mean sensitivity and specificity of 79/55 and 70/100%, respectively, using the supression cut-offs of >50% and >80%, respectively. The diagnostic accuracy of CRH test and desmopressin test did not significantly differ (P=0.28) in the distinction between CD and EAS. The combination of HDDST and CRH or desmopressin tests was more accurate than each test alone. The overall diagnostic accuracy of BIPPS was 94%. Pituitary MRI depicted all macroadenomas and 64% of microadenomas. CT scan and/or MRI detected 90% of bronchial carcinoid, as well as all thymic carcinoid.

Conclusion: CD and EAS cannot be accurately be distinguished based only on clinical and biochemical features. LNSC was the most sensitive screening test for CS.

Volume 49

19th European Congress of Endocrinology

Lisbon, Portugal
20 May 2017 - 23 May 2017

European Society of Endocrinology 

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