title: Diagnostic tests for Cushing's syndrome differ from published guidelines: data from ERCUSYN.
abstract: To evaluate which tests are performed to diagnose hypercortisolism in patients included in the European Registry on Cushing's syndrome (ERCUSYN), and to examine if their use differs from the current guidelines.
  
  
  
  We analyzed data on the diagnostic tests performed in 1341 patients with Cushing's syndrome (CS) who have been entered into the ERCUSYN database between January 1, 2000 and January 31, 2016 from 57 centers in 26 European countries. Sixty-seven percent had pituitary-dependent CS (PIT-CS), 24% had adrenal-dependent CS (ADR-CS), 6% had CS from an ectopic source (ECT-CS) and 3% were classified as having CS from other causes (OTH-CS).
  
  
  
  Of the first-line tests, urinary free cortisol (UFC) test was performed in 78% of patients, overnight 1 mg dexamethasone suppression test (DST) in 60% and late-night salivary cortisol (LSaC) in 25%. Use of LSaC increased in the last five years as compared with previous years (P< 0.01). Use of HDDST was slightly more frequent in the last 5 years as compared with previous years (P< 0.05). Of the additional tests, late-night serum cortisol (LSeC) was measured in 62% and 48-h 2 mg/day low-dose dexamethasone suppression test (LDDST) in 33% of cases. ACTH was performed in 78% of patients. LSeC and overnight 1 mg DST supported the diagnosis of both PIT-CS and ADR-CS more frequently than UFC (P< 0.05).
  
  
  
  Use of diagnostic tests for CS varies across Europe and partly differs from the currently available guidelines. It would seem pertinent that a European consensus be established to determine the best diagnostic approach to CS, taking into account specific inter-country differences with regard to the availability of diagnostic tools.
authors.affiliation: IIB-Sant Pau and Department of Endocrinology/MedicineHospital Sant Pau, UAB, and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, Barcelona, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Valassi
authors.affiliation: Lohmann & Birkner Health Care Consulting GmbHBerlin, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Franz
authors.affiliation: Aix-Marseille UniversitéCNRS, CRN2M UMR 7286, and APHM, Hôpital Conception, Marseille, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Brue
authors.affiliation: Erasmus University Medical CentreRotterdam, The Netherlands.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Feelders
authors.affiliation: Radboud University Medical CentreNijmegen, The Netherlands.
authors.forename: Romana
authors.initials: R
authors.lastname: Netea-Maier
authors.affiliation: Athens Polyclinic General HospitalEvangelismos Hospital, Athens, Greece.
authors.forename: Stylianos
authors.initials: S
authors.lastname: Tsagarakis
authors.affiliation: IIB-Sant Pau and Department of Endocrinology/MedicineHospital Sant Pau, UAB, and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, Barcelona, Spain.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Webb
authors.affiliation: Medical University of SofiaSofia, Bulgary.
authors.forename: Maria
authors.initials: M
authors.lastname: Yaneva
authors.affiliation: Medizinische Klinik und Poliklinik IVCampus Innestadt, Klinikum der Universität München, München, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Reincke
authors.affiliation: Praxis für Endokrinologie DrosteOldenburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Droste
authors.affiliation: Moscow Regional Research Clinical InstituteMoscow, Russia.
authors.forename: Irina
authors.initials: I
authors.lastname: Komerdus
authors.affiliation: UCL Cliniques Universitaires St LucBrussels, Belgium.
authors.forename: Dominique
authors.initials: D
authors.lastname: Maiter
authors.affiliation: Department of EndocrinologyUniversity Hospital Zagreb, School of Medicine University of Zagreb, Zagreb, Croatia.
authors.forename: Darko
authors.initials: D
authors.lastname: Kastelan
authors.affiliation: Univ Paris-SudUniversité Paris-Saclay UMR-S1185, Le Kremlin Bicêtre, Paris, France.|Assistance Publique-Hôpitaux de ParisHôpital de Bicêtre, Service de Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre, Paris, France.|Institut National de la Santé et de la Recherche Médicale U1185Le Kremlin Bicêtre, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Chanson
authors.affiliation: Department of EndocrinologyUniversity Medical Centre Ljubljana, Ljubljana, Slovenia.
authors.forename: Marija
authors.initials: M
authors.lastname: Pfeifer
authors.affiliation: Division of Clinical EndocrinologyDepartment of Medicine CCM, Charité-Universitätsmedizin, Berlin, Germany.
authors.forename: Christian J
authors.initials: CJ
authors.lastname: Strasburger
authors.affiliation: 2nd Department of MedicineSemmelweis University, Budapest, Hungary.
authors.forename: Miklós
authors.initials: M
authors.lastname: Tóth
authors.affiliation: Service d'Endocrinologie-Diabétologie-NutritionGrenoble Cedex, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Chabre
authors.affiliation: Centre Hospitalier Universitaire de BordeauxBordeaux, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Tabarin
authors.affiliation: 2nd Department of Internal Medicine3rd Faculty of Medicine and University Hospital Kralovske Vinohrady, Prague, Czech Republic.
authors.forename: Michal
authors.initials: M
authors.lastname: Krsek
authors.affiliation: Department of EndocrinologyHospital Universitario de la Ribera, Alzira, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Fajardo
authors.affiliation: Department of EndocrinologyDiabetology and Isotope Therapy, Wroclaw Medical University, Wroclaw, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Bolanowski
authors.affiliation: IIB-Sant Pau and Department of Endocrinology/MedicineHospital Sant Pau, UAB, and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, Barcelona, Spain.
authors.forename: Alicia
authors.initials: A
authors.lastname: Santos
authors.affiliation: Oxford Radcliffe Hospitals NHS TrustOxford, UK.
authors.forename: John A H
authors.initials: JAH
authors.lastname: Wass
authors.affiliation: Department of EndocrinologyChristie Hospital, Manchester, UK.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Trainer
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000378:metabolism; D000328:Adult; D000368:Aged; D003480:Cushing Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000378:metabolism*; D003955:Diagnostic Tests, Routine / Q000592:standards* / Q000706:statistics & numerical data; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards*; D012042:Registries; D013223:Statistics as Topic / Q000379:methods
chemical_list: D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone