ECE2020 Audio ePoster Presentations Pituitary and Neuroendocrinology (217 abstracts)
The importance of DHEA-S levels in cushing’s syndrome; is there a cut-off value in the differential diagnosis?
Sema Ciftci Dogansen 1 , Ozlem Soyluk Selcukbiricik 2 , Alev Selek 3 , Selvinaz Erol 4 , Zeliha Hekimsoy 5 , Ayse Esen Pazir 1 , Huseyin Dursun 6 , Serdar Sahin 7 , Gonca Oruk 8 , Meral Mert 1 , Hüseyin Soylu 9 , Banu Sarer Yurekli 10 , Melek Eda Ertorer 11 , Tülay Omma 12 , Mehtap Evran 13 , Mine Adaș 14 , Seher Tanrikulu 15 , Kadriye Aydin 16 , Zafer Pekkolay 17 , Bulent Can 18 , Ersen Karakilic 19 , Zuleyha Karaca 6 , Habib Bilen 20 , Zeynep Canturk 3 , Berrin Cetinarslan 3 , Pinar Kadioglu 7 & Sema Yarman 21
1Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey; 2Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey; 3Kocaeli University, Faculty of Medicine, Kocaeli, Turkey; 4Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey; 5Celal Bayar University Medicine Faculty, Manisa, Turkey; 6Erciyes University Medical School, Kayseri, Turkey; 7Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey; 8İzmir Ataturk Training and Research Hospital, Division of Endocrinology and Metabolism, Izmir, Turkey; 9Division of Endocrinology and Metabolism, Ondokuz Mayıs University, Samsun, Turkey; 10Department of Endocrinology, Ege University Faculty of Medicine, Izmir, Turkey; 11Department of Endocrinology and Metabolism Diseases, Faculty of Medicine, Baskent University, Adana, Turkey; 12Division of Endocrinology and Metabolism, Ankara Training and Research Hospital, Ankara,Turkey; 13Cukurova University Faculty of Medicine, Adana, Turkey; 14Department of Endocrinology, Ministry of Health Okmeydani Research and Training Hospital, Health Sciences University, Istanbul, Turkey; 15Division of Endocrinology and Metabolism, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey; 16Department of Endocrinology and Metabolic Disease, Dr. Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey; 17Dicle University School of Medicine Adult Endocrinology Department, Diyarbakir, Turkey; 18Endocrinology and Metabolism Department, Istanbul Civilization University, Istanbul, Turkey; 19Endocrinology and Metabolism, Canakkale Onsekiz Mart Universitesi Tip Fakultesi, Canakkale, Turkey; 20Division of Endocrinology and Metabolism, Ataturk University School of Medicine, Erzurum, Turkey; 21Istanbul University, Istanbul, Turkey
Purpose: To evaluate the relationship between basal dehydroepiandrosterone-sulfate (DHEA-S) levels and other tests used in the diagnosis and differential diagnosis of Cushing’s Syndrome (CS) among the patients with pathologically confirmed CS.
Methods: In this multicenter study, the data of 623 patients with CS were evaluated retrospectively. The patients were classified as Group 1 (n = 353 Cushing’s disease;CD), Group 2 (n = 242 adrenal CS) and Group 3 (n = 28 ectopic ACTH syndrome; EAS). The groups were compared in terms of demographic data, estimated duration to diagnosis of CS, pre-operative ACTH, basal cortisol, DHEA-S, 24-hour urinary free cortisol (24 h-UFC) levels and dexamethasone suppression test (DST) results. Correlations between DHEA-S levels and all parameters were evaluated. A ROC curve was produced to calculate the optimal DHEA-S cut-off value in the differential diagnosis of CS. The effectiveness of the calculated DHEA-S cut-off level in demonstrating the accurate etiology of patients with gray zone in terms of ACTH levels (10–20 pg/ml) was assessed.
Results: The Group 1 patients were younger than the Group 2 patients (P < 0.001), while Group 3 had more male patients than the others (P < 0.001). Basal cortisol, ACTH, 24 h-UFC levels were significantly different between the three groups (Group 3>Group 1>Group 2), (P < 0.001, for all comparisons). The DHEA-S level was significantly lower in Group 2 compared to the other two groups (P < 0.001), while Group 1 and Group 3 had similar DHEA-S levels. There was a negative correlation between DHEA-S levels and age at diagnosis (r = −0.184, P < 0.0001) and high-dose DST (r = −0.133, P < 0.0001); and a positive correlation between basal cortisol (r = 0.247, P < 0.0001), ACTH (r = 0.550, P < 0.0001) and 24 h-UFC levels (r = 0.172, P < 0.0001).No significant correlation was found between DHEA-S levels and other parameters. The optimal cut-off DHEA-S value that providing differential diagnosis of CS was calculated to be 43.2 µg/dl [sensitivity of 88%(79–93%) and specificity of 76% (70–82%)] between Group 1 and Group 2. This DHEA-S cut-off level demonstrated the accurate etiology in 93% of 14 CD and 100% of 44 adrenal CS in patients with gray zone in terms of ACTH levels. The optimal DHEA-S cut-off value that providing differential diagnosis of CS was calculated to be 136.5 µg/dl [sensitivity of 91% (87–98%) and specificity of 73% (69–81%)] between Group 2 and Group 3. No significant cut-off level was found between Group 1 and Group 3.
Conclusion: This study showed that the DHEA-S cut-off value could be used for differential diagnosis of CD and adrenal CS with high sensitivity and specificity, at the initial evaluation.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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