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14-03-2023 | Cushing's Syndrome | Original Article

The addition of corticotropin-releasing hormone to 2-day low dose dexamethasone suppression test provides additional case detection

Authors: Leen Wehbeh, Ula Abed Alwahab, Alexandra Mikhael, Georgiana Dobri, Divya Yogi-Morren, Laurence Kennedy, Amir H. Hamrahian

Published in: Endocrine | Issue 2/2023

Abstarct

Purpose

The diagnostic value of adding a Corticotropin-Releasing Hormone (CRH) Stimulation Test to the 2-day Low Dose Dexamethasone Suppression Test (Dex-CRH Test) has been debated in the literature.

Methods

We identified 65 patients with Cushing disease (CD) and 42 patients in whom a diagnosis of Cushing disease could not be confirmed (NCD) after a minimum follow-up of 14 months who underwent the Dex-CRH test.

Results

The female sex ratio, median (range) age, and BMI were similar between the two groups. The follow-up for patients with CD and NCD was 74 (4–233) and 52 (14–146) months, respectively. Among 65 patients with CD, 5 (7.7%) had a cortisol level ≤1.4 µg/dl after LDDST but were appropriately classified as CD with a cortisol level >1.4 µg/dL at 15-min post CRH stimulation. In contrast, 3/42 patients (7.1%) in NCD had an abnormal Dex-CRH test. In only one of three patients, the LDDST was marginally normal (cortisol was 1.4 µg/dL and increased to 3.1 µg/dL 15-min post CRH). A cortisol cutoff value of >1.4 µg/dL during the Dex-CRH test provided a sensitivity of 100%, specificity of 93%, and diagnostic accuracy of 97% to diagnose CD. When patients without a Dex level were excluded (n = 74), the sensitivity did not change, but the specificity and accuracy of the Dex-CRH test increased to 97 and 99%, respectively.

Conclusion

The Dex-CRH Test provided additional case detection in 5/65 (7.7%) patients with CD. It resulted in one false-positive case compared to LDDST. Measurement of dexamethasone improved diagnostic accuracy of the test.

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Title: The addition of corticotropin-releasing hormone to 2-day low dose dexamethasone suppression test provides additional case detection
Authors: Leen Wehbeh
Ula Abed Alwahab
Alexandra Mikhael
Georgiana Dobri
Divya Yogi-Morren
Laurence Kennedy
Amir H. Hamrahian
Publication date: 14-03-2023
Publisher: Springer US
Keywords: Cushing's Syndrome
Endogenous Cushing's Syndrome
Dexamethasone
Published in: Endocrine / Issue 2/2023
Print ISSN: 1355-008X
Electronic ISSN: 1559-0100
DOI: https://doi.org/10.1007/s12020-023-03327-5

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