背景:一旦证实了高皮质醇血症,肿瘤性内源性皮质醇增多症和非肿瘤性皮质醇增多症致库欣综合征(CS)的鉴别诊断(NNH,假性库欣综合征)至关重要。由于全球促肾上腺皮质激素释放激素(CRH)不可用,地塞米松(Dex)-CRH替代试验的准确性,显然是需要的。
目的:评估Dex-CRH检验的诊断准确性,去氨加压素刺激试验,午夜血清皮质醇(MSC),和深夜唾液皮质醇(LNSC)水平来区分CS和NNH。
方法:到2022年3月的文章来自Scopus,WebofScience,MEDLINE,EMBASE,和PubMed。通过系统审查的所有步骤都是独立和一式两份的,并严格遵守更新的PRISMA-DTA清单。
结果:共纳入24篇文章(1900例患者)。Dex-CRH的合并敏感性和特异性分别为91%(95CI87-94%;I20%)和82%(73-88%;I250%),去氨加压素试验86%(81-90%;I228%)和90%(84-94%;I215%),MSC91%(85-94%;I266%)和81%(70-89%;I271%),LNSC80%(67-89%;I257%)和90%(84-93%;I221%),分别。总结受试者工作特征曲线下面积为Dex-CRH0.949,去氨加压素试验0.936,MSC0.942和LNSC0.950,无视觉或统计学意义。研究偏倚的总体风险中等。
结论:Dex-CRH,去氨加压素刺激试验,和MSC具有相似的诊断准确性,Dex-CRH和MSC的灵敏度略高,去氨加压素试验更具体。LNSC是最不准确的,可能是由于高度异质性,内在变异性,不同的化验,和缺乏一致的报告截止。面对这个具有挑战性的鉴别诊断,这里提供的结果应该会增加临床医生在决定进行哪种测试时的信心.
BACKGROUND: Once hypercortisolemia is confirmed, differential diagnosis between Cushing\'s syndrome (CS) due to neoplastic endogenous hypercortisolism and non-neoplastic hypercortisolism (NNH, pseudo-Cushing\'s syndrome) is crucial. Due to worldwide corticotropin-releasing hormone (CRH) unavailability, accuracy of alternative tests to dexamethasone (Dex)-CRH, is clearly needed.
OBJECTIVE: Assess the diagnostic accuracy of Dex-CRH test, desmopressin stimulation test, midnight serum cortisol (MSC), and late-night salivary cortisol (LNSC) levels to distinguish CS from NNH.
METHODS: Articles through March 2022 were identified from Scopus, Web of Science, MEDLINE, EMBASE, and PubMed. All steps through the systematic review were performed independently and in duplicate and strictly adhered to the updated PRISMA-DTA checklist.
RESULTS: A total of 24 articles (1900 patients) were included. Dex-CRH had a pooled sensitivity and specificity of 91% (95%CI 87-94%; I2 0%) and 82% (73-88%; I2 50%), desmopressin test 86% (81-90%; I2 28%) and 90% (84-94%; I2 15%), MSC 91% (85-94%; I2 66%) and 81% (70-89%; I2 71%), and LNSC 80% (67-89%; I2 57%) and 90% (84-93%; I2 21%), respectively. Summary receiver operating characteristics areas under the curve were Dex-CRH 0.949, desmopressin test 0.936, MSC 0.942, and LNSC 0.950 without visual or statistical significance. The overall risk of studies bias was moderate.
CONCLUSIONS: Dex-CRH, the desmopressin stimulation test, and MSC have similar diagnostic accuracy, with Dex-CRH and MSC having slightly higher sensitivity, and the desmopressin test being more specific. LNSC was the least accurate, probably due to high heterogeneity, intrinsic variability, different assays, and lack of consistent reported cutoffs. When facing this challenging differential diagnosis, the results presented here should increase clinicians\' confidence when deciding which test to perform.