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.
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.
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.
方法:我们确定了65例库欣病(CD)患者和42例库欣病(NCD)患者,经过最少14个月的随访,并进行了Dex-CRH测试。
结果:女性性别比例,中位(范围)年龄,两组的BMI相似。CD和NCD患者的随访时间为74(4-233)和52(14-146)个月,分别。在65例CD患者中,5(7.7%)在LDDST后皮质醇水平≤1.4µg/dl,但在CRH刺激后15分钟被适当分类为CD,皮质醇水平>1.4µg/dL。相比之下,3/42例(7.1%)NCD患者的Dex-CRH检测异常。只有三个病人中的一个,LDDST基本正常(皮质醇为1.4µg/dL,CRH后15分钟增加至3.1µg/dL).在Dex-CRH测试中,皮质醇临界值>1.4µg/dL提供了100%的灵敏度,特异性为93%,诊断CD的准确率为97%。当没有Dex水平的患者被排除在外(n=74),灵敏度没有改变,但是Dex-CRH测试的特异性和准确性提高到97%和99%,分别。
结论:Dex-CRH测试在5/65(7.7%)的CD患者中提供了额外的病例检测。与LDDST相比,它导致了一个假阳性病例。地塞米松的测量提高了测试的诊断准确性。