A practice guideline issued by the Endocrine Society in 2008 for screening and diagnosing Cushing’s syndrome (CS) remains valid in 2022, according to a paper published in The Journal of Clinical Endocrinology and Metabolism.
“Based on the guideline of the US Endocrine Society in 2008, adult patients with unusual symptoms for their age (eg, osteoporosis, hypertension), with multiple and progressive symptoms, particularly those that are more predictive of CS, and with adrenal incidentaloma compatible with adenoma should be screened,” the researchers wrote. “The same applies to children with below average height and above average weight.”
Leah T. Braun, MD, and colleagues noted that “a contemporary reassessment” of the guidelines was warranted to show that phenotypic presentation has not changed because of secular trends in obesity, diabetes, and hypertension epidemiology. They examined 377 patients with suspected CS, specifically looking at urinary-free cortisol, late-night salivary cortisol, and the 1 mg dexamethasone suppression test as well as long-term clinical observation.
CS was confirmed in 93 patients and ruled out in the rest of the study population (N=284). Specific subtypes included pituitary CS (67%), adrenal CS (28%), and ectopic CS (5%). Most patients in the CS group and the non-CS group were women (76% for both). Patients with CS were older than patients who did not have CS (median age, 49 vs 36).
Five Indications for Screening Increase CS Probability
Of the 18 key symptoms for which patients were referred, five occurred more frequently in patients with confirmed CS versus those in whom CS was ruled out, including osteoporosis (8% vs 2%; P=0.02), adrenal incidentaloma (17% vs 8%; P=0.01), metabolic syndrome (11% vs 4%; P=0.02), myopathy (10% vs 2%; P<0.001), and the existence of numerous symptoms (16% vs 1%; P<0.001). Obesity occurred more frequently among patients in whom CS was ruled out (30% vs 4%; P<0.001), although recent weight gain was pronounced in those with CS.
“A total of 73% of patients with CS had typical chief complaints, as did 37% of patients with ruled-out CS status, according to the Endocrine Society practice guideline 2008,” Dr. Braun and colleagues wrote.
The primary finding associated with this study is that the 2008 guideline recommendations remain valid, the researchers noted. They also addressed the value of their results in clinical practice.
“Analyzing presenting problems in patients with suspected CS revealed that [five] reasons for screening increase the likelihood of having CS (myopathy, metabolic syndrome, osteoporosis, adenoma, and multiple CS-specific symptoms), while obesity as chief complaint is the single factor to significantly decrease probability of CS,” Dr. Braun and colleagues wrote. “Although clinical practice differs from official recommendations, our study underlines the validity of the recommendations of the 2008 Endocrine Society Practice guideline: Patients falling into [one of the three] at-risk groups of patients [have] a reasonable to high likelihood for [CS screening].”
