title: The role of non-invasive dynamic tests in the diagnosis of Cushing's syndrome.
abstract: OBJECTIVE
  To evaluate the role of non-invasive dynamic tests in the diagnosis and differential diagnosis of Cushing's syndrome (CS).
  
  
  METHODS
  We studied laboratory features of 74 patients with endogenous CS, subdivided as follows: 46 (62.1%) with Cushing's disease (CD), 21 (28.3%) with an adrenal tumor, and 7 (9.5%) with ectopic ACTH syndrome (EAS).
  
  
  RESULTS
  In 100% of cases of CS we found serum cortisol levels greater than 1.8 microg/dl after low-dose dexamethasone suppression tests (LDDST), as well as elevation of midnight serum or salivary cortisol. However, urinary free cortisol was normal in 11.5% of patients. ACTH levels were suppressed in patients with adrenal tumors, normal or high in CD and invariably increased in EAS. After the 8-mg overnight dexamethasone suppression test (HDDST), serum cortisol suppression >50% was observed in 79.5% of cases of CD and in 28.6% of subjects with EAS, whereas cortisol suppression >80% was only found in CD. After stimulation with CRH or desmopressin an ACTH rise > or =35% occurred in 86.5% of individuals with CD and 14.3% of those with EAS, whereas an ACTH rise > or =50 achieved 100% specificity. Moreover, the combination of serum cortisol suppression >50% after HDDST and an ACTH increase > or =35% after the administration of CRH or desmopressin only occurred in CD.
  
  
  CONCLUSIONS
  Our findings demonstrate that LDDST had 100% sensitivity for the diagnosis of CS and that HDDST and stimulation tests with CRH or desmopressin may be very useful for confirmation of CS etiology when analyzed together or when more stringent cut-offs are used.
authors.affiliation: Division of Endocrinology, Hospital das Clínicas, Pernambuco Federal University, Recife, Brazil. lvilar@gmail.com
authors.forename: L
authors.initials: L
authors.lastname: Vilar
authors.forename: M C
authors.initials: MC
authors.lastname: Freitas
authors.forename: L A
authors.initials: LA
authors.lastname: Naves
authors.forename: V
authors.initials: V
authors.lastname: Canadas
authors.forename: J L
authors.initials: JL
authors.lastname: Albuquerque
authors.forename: C A
authors.initials: CA
authors.lastname: Botelho
authors.forename: C S
authors.initials: CS
authors.lastname: Egito
authors.forename: M J
authors.initials: MJ
authors.lastname: Arruda
authors.forename: L M
authors.initials: LM
authors.lastname: Silva
authors.forename: C M
authors.initials: CM
authors.lastname: Arahata
authors.forename: R
authors.initials: R
authors.lastname: Agra
authors.forename: L H C
authors.initials: LH
authors.lastname: Lima
authors.forename: M
authors.initials: M
authors.lastname: Azevedo
authors.forename: L A
authors.initials: LA
authors.lastname: Casulari
mesh_terms: D000182:ACTH Syndrome, Ectopic / Q000175:diagnosis*; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis; D003346:Corticotropin-Releasing Hormone; D003480:Cushing Syndrome / Q000175:diagnosis*; D003894:Deamino Arginine Vasopressin; D003907:Dexamethasone; D003937:Diagnosis, Differential; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008279:Magnetic Resonance Imaging; D047748:Pituitary ACTH Hypersecretion / Q000175:diagnosis; D010902:Pituitary Gland / Q000473:pathology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012463:Saliva / Q000737:chemistry; D012680:Sensitivity and Specificity
chemical_list: D003907:Dexamethasone; D003346:Corticotropin-Releasing Hormone; D003894:Deamino Arginine Vasopressin; D006854:Hydrocortisone