The Utility of Preoperative ACTH/Cortisol Ratio for the Diagnosis and Prognosis of Cushing's Disease
Purpose: Cushing's syndrome (CS) is a rare disease having diagnostic difficulties. Many diagnostic tests have been defined but none of these are diagnostic alone. Determination of the cause is another problem which sometimes requires more sophisticated and invasive procedures. Therefore, we aim...
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doaj-604c8c5356cf43f297138a6e4c9269972021-04-02T13:40:07ZengThieme Medical and Scientific Publishers Pvt. Ltd.Journal of Neurosciences in Rural Practice0976-31470976-31552018-01-01090110611110.4103/jnrp.jnrp_308_17The Utility of Preoperative ACTH/Cortisol Ratio for the Diagnosis and Prognosis of Cushing's DiseaseAlev Selek0Berrin Cetinarslan1Zeynep Canturk2Ilhan Tarkun3Ozlem Zeynep Akyay4Burak Cabuk5Savas Ceylan6Departments of Endocrinology and Methabolism and Kocaeli University, Umuttepe Kocaeli, TurkeyDepartments of Endocrinology and Methabolism and Kocaeli University, Umuttepe Kocaeli, TurkeyDepartments of Endocrinology and Methabolism and Kocaeli University, Umuttepe Kocaeli, TurkeyDepartments of Endocrinology and Methabolism and Kocaeli University, Umuttepe Kocaeli, TurkeyDepartments of Endocrinology and Methabolism and Kocaeli University, Umuttepe Kocaeli, TurkeyNeurosurgery, Faculty of Medicine, Kocaeli University, Umuttepe Kocaeli, TurkeyNeurosurgery, Faculty of Medicine, Kocaeli University, Umuttepe Kocaeli, TurkeyPurpose: Cushing's syndrome (CS) is a rare disease having diagnostic difficulties. Many diagnostic tests have been defined but none of these are diagnostic alone. Determination of the cause is another problem which sometimes requires more sophisticated and invasive procedures. Therefore, we aimed to evaluate the utility of pretreatment plasma adrenocorticotropic hormone (ACTH)/cortisol ratios in patients with confirmed endogenous CS for the diagnosis and differential diagnosis of CS. Materials and Methods: This retrospective evaluation included 145 patients with the diagnosis of CS, 119 patients with Cushing's disease (CD), and 26 patients with ACTH-independent CS (AICS), in a university hospital. Furthermore, 114 individuals in whom CS diagnosis was excluded with at least one negative screening test were enrolled to the study as control group. The clinical, laboratory, imaging, postsurgical pathologic records and also clinical follow-up data of all patients were evaluated. Results: The median basal ACTH/cortisol ratio of the patients with CD was significantly higher than AICS and controls. A cutoff ACTH/cortisol ratio >2.5 was found to be diagnostic for CD with 82% specificity and 63% sensitivity. Among CD group, patients with recurrent disease had higher preoperative ACTH levels and ACTH/cortisol ratio than patients with sustained remission. Furthermore, these patients had more invasive, atypical, and larger tumors. Conclusion: An ACTH/cortisol ratio >2.5 would be beneficial to diagnose CD together with other diagnostic tests. It is a simple test with no additional cost. Higher ratios might be related with larger, invasive, and atypical adenoma and also might be helpful to predict recurrence.http://www.thieme-connect.de/DOI/DOI?10.4103/jnrp.jnrp_308_17 adrenocorticotropic hormone/cortisol ratio cushing's disease diagnosis of cushing's syndrome recurrent cushing's disease |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Alev Selek Berrin Cetinarslan Zeynep Canturk Ilhan Tarkun Ozlem Zeynep Akyay Burak Cabuk Savas Ceylan |
spellingShingle |
Alev Selek Berrin Cetinarslan Zeynep Canturk Ilhan Tarkun Ozlem Zeynep Akyay Burak Cabuk Savas Ceylan The Utility of Preoperative ACTH/Cortisol Ratio for the Diagnosis and Prognosis of Cushing's Disease Journal of Neurosciences in Rural Practice adrenocorticotropic hormone/cortisol ratio cushing's disease diagnosis of cushing's syndrome recurrent cushing's disease |
author_facet |
Alev Selek Berrin Cetinarslan Zeynep Canturk Ilhan Tarkun Ozlem Zeynep Akyay Burak Cabuk Savas Ceylan |
author_sort |
Alev Selek |
title |
The Utility of Preoperative ACTH/Cortisol Ratio for the Diagnosis and Prognosis of Cushing's Disease |
title_short |
The Utility of Preoperative ACTH/Cortisol Ratio for the Diagnosis and Prognosis of Cushing's Disease |
title_full |
The Utility of Preoperative ACTH/Cortisol Ratio for the Diagnosis and Prognosis of Cushing's Disease |
title_fullStr |
The Utility of Preoperative ACTH/Cortisol Ratio for the Diagnosis and Prognosis of Cushing's Disease |
title_full_unstemmed |
The Utility of Preoperative ACTH/Cortisol Ratio for the Diagnosis and Prognosis of Cushing's Disease |
title_sort |
utility of preoperative acth/cortisol ratio for the diagnosis and prognosis of cushing's disease |
publisher |
Thieme Medical and Scientific Publishers Pvt. Ltd. |
series |
Journal of Neurosciences in Rural Practice |
issn |
0976-3147 0976-3155 |
publishDate |
2018-01-01 |
description |
Purpose: Cushing's syndrome (CS) is a rare disease having diagnostic difficulties. Many diagnostic tests have been defined but none of these are diagnostic alone. Determination of the cause is another problem which sometimes requires more sophisticated and invasive procedures. Therefore, we aimed to evaluate the utility of pretreatment plasma adrenocorticotropic hormone (ACTH)/cortisol ratios in patients with confirmed endogenous CS for the diagnosis and differential diagnosis of CS. Materials and Methods: This retrospective evaluation included 145 patients with the diagnosis of CS, 119 patients with Cushing's disease (CD), and 26 patients with ACTH-independent CS (AICS), in a university hospital. Furthermore, 114 individuals in whom CS diagnosis was excluded with at least one negative screening test were enrolled to the study as control group. The clinical, laboratory, imaging, postsurgical pathologic records and also clinical follow-up data of all patients were evaluated. Results: The median basal ACTH/cortisol ratio of the patients with CD was significantly higher than AICS and controls. A cutoff ACTH/cortisol ratio >2.5 was found to be diagnostic for CD with 82% specificity and 63% sensitivity. Among CD group, patients with recurrent disease had higher preoperative ACTH levels and ACTH/cortisol ratio than patients with sustained remission. Furthermore, these patients had more invasive, atypical, and larger tumors. Conclusion: An ACTH/cortisol ratio >2.5 would be beneficial to diagnose CD together with other diagnostic tests. It is a simple test with no additional cost. Higher ratios might be related with larger, invasive, and atypical adenoma and also might be helpful to predict recurrence. |
topic |
adrenocorticotropic hormone/cortisol ratio cushing's disease diagnosis of cushing's syndrome recurrent cushing's disease |
url |
http://www.thieme-connect.de/DOI/DOI?10.4103/jnrp.jnrp_308_17 |
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