title: A clinical index for rating severity in Cushing's syndrome.
abstract: BACKGROUND
  In assessing the clinical response to medical and/or surgical treatments in patients with established Cushing's syndrome, the need for an instrument that could measure the magnitude of changes in the most common symptoms was felt. We therefore tested the usefulness of a simple clinical index, the Cushing's syndrome severity index (CSI), based on clinimetric principles. Eight clinical features were selected. Each one was graded on an ordinal 3-point scale (0-2) with specification of anchor points based on severity. The total score ranged from 0 to 16.
  
  
  METHODS
  Interrater agreement, construct validity and concurrent validity of the index were evaluated. Fourteen patients with Cushing's syndrome were evaluated independently by 2 endocrinologists before and after successful treatment. The CSI and two global scales of illness severity were administered. Urinary cortisol measurements were also performed.
  
  
  RESULTS
  The intraclass correlation coefficient of the CSI was 0.95 before treatment and 0.87 after treatment. The CSI significantly discriminated (p<0.001) the effects of treatment and paralleled the changes in urinary cortisol. There were significant correlations between CSI and global scales of illness severity and change after treatment.
  
  
  CONCLUSIONS
  The results indicate that the CSI is a valid and reliable clinimetric method to evaluate severity in Cushing's syndrome. It may provide a tool for better assessing the complex array of signs and symptoms in this condition. The index is suitable for descriptive studies, outcome investigations and treatment trials.
authors.affiliation: Department of Surgical and Medical Sciences, Division of Endocrinology, University of Padova, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Sonino
authors.forename: M
authors.initials: M
authors.lastname: Boscaro
authors.forename: F
authors.initials: F
authors.lastname: Fallo
authors.forename: G A
authors.initials: GA
authors.lastname: Fava
mesh_terms: D000293:Adolescent; D000328:Adult; D003480:Cushing Syndrome / Q000175:diagnosis* / Q000453:epidemiology; D003863:Depression / Q000175:diagnosis; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012720:Severity of Illness Index
chemical_list: D006854:Hydrocortisone