Toward a Diagnostic Score in Cushing's Syndrome

    November 2019 in “ Frontiers in Endocrinology ”
    Leah Braun, Anna Riester, A Osswald-Kopp, Julia Fazel, German Rubinstein, Martin Bidlingmaier, Felix Beuschlein, Martin Reincke
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    TLDR The document suggests creating a validated score to diagnose Cushing's Syndrome and considers plasma steroid profiling as a simpler diagnostic method.
    The document from 2019 highlights the difficulties in diagnosing Cushing's Syndrome (CS) due to its rarity and nonspecific symptoms, which often overlap with metabolic syndrome, leading to an average diagnostic delay of 34 months. It reviews diagnostic strategies, including a clinical score with 96% sensitivity and 83% specificity, and automated face recognition with moderate accuracy. The document also addresses the inefficiency of widespread screening for CS due to its low prevalence, with the US Endocrine Society recommending screening only for patients with multiple or unusual symptoms, children with growth issues, and those with adrenal incidentalomas. Additionally, it discusses the limitations of biochemical tests like the Low-Dose Dexamethasone Suppression Test and Urine Free Cortisol test, which can yield false results, and the influence of various factors on the Late-Night Salivary Cortisol test. The document suggests the need for a validated clinical score for CS diagnosis and notes the potential of plasma steroid metabolome profiling to simplify the diagnostic process.
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