title: Nonconformity in the clinical practice guidelines for subclinical Cushing's syndrome: which guidelines are trustworthy?
abstract: OBJECTIVE
  This study aimed to systematically evaluate the quality of clinical practice guidelines (CPGs) and to compare their recommendations for managing subclinical Cushing's syndrome (SCS) to assist practitioners in making rapid clinical decisions.
  
  
  METHODS
  SCS management guidelines were retrieved from electronic databases. The Appraisal of Guidelines Research and Evaluation II (AGREE-II) tool and the Institute of Medicine (IOM) criteria were used to evaluate the quality of the selected guidelines. In addition, we further compared recommendations, cited references and levels of evidence between the SCS management guidelines.
  
  
  RESULTS
  We included five guidelines that were obtained through the literature selection process. On the basis of the AGREE-II and IOM criteria, none of the selected guidelines were satisfactory in all aspects. However, the Italian Association of Clinical Endocrinologists (IACE) guidelines demonstrated slightly higher scores than did the other guidelines, so this guideline was recommended (with certain modifications for several domains). Regarding the content of the CPGs, we found considerable differences in the recommendations for managing SCS. These differences were derived from citation selection bias, evidence interpretation bias, differences in the composition of the guidelines' workgroups and the omission of guidelines for updating and externally reviewing the recommendations.
  
  
  CONCLUSIONS
  There is generally poor guideline quality among different organisations, and remarkable differences exist in the recommendations for the same clinical subject. Therefore, future guideline development should be performed in strict accordance with the AGREE-II and IOM criteria.
authors.affiliation: Department of EndocrinologyThe First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, People's Republic of China.
authors.forename: Jing
authors.initials: J
authors.lastname: Shen
authors.affiliation: Department of EndocrinologyThe First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, People's Republic of China.
authors.forename: Mingfang
authors.initials: M
authors.lastname: Sun
authors.affiliation: Department of EndocrinologyThe First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, People's Republic of China zhoubo915@126.com.
authors.forename: Bo
authors.initials: B
authors.lastname: Zhou
authors.affiliation: Department of EndocrinologyThe First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, People's Republic of China.
authors.forename: Juping
authors.initials: J
authors.lastname: Yan
mesh_terms: D003480:Cushing Syndrome / Q000175:diagnosis / Q000628:therapy; D016208:Databases, Factual; D019317:Evidence-Based Medicine / Q000592:standards; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D015969:National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division; D017410:Practice Guidelines as Topic / Q000592:standards*; D014481:United States