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. 2018 Jan-Mar;9(1):106-111.
doi: 10.4103/jnrp.jnrp_308_17.

The Utility of Preoperative ACTH/Cortisol Ratio for the Diagnosis and Prognosis of Cushing's Disease

Alev Selek  1 , Berrin Cetinarslan  1 , Zeynep Canturk  1 , Ilhan Tarkun  1 , Ozlem Zeynep Akyay  1 , Burak Cabuk  2 , Savas Ceylan  2
Affiliations

The Utility of Preoperative ACTH/Cortisol Ratio for the Diagnosis and Prognosis of Cushing's Disease

Alev Selek et al. J Neurosci Rural Pract. 2018 Jan-Mar.

Abstract

Purpose: Cushing's syndrome (CS) is a rare disease having diagnostic difficulties. Many diagnostic tests have been defined but none of these are diagnostic alone. Determination of the cause is another problem which sometimes requires more sophisticated and invasive procedures. Therefore, we aimed to evaluate the utility of pretreatment plasma adrenocorticotropic hormone (ACTH)/cortisol ratios in patients with confirmed endogenous CS for the diagnosis and differential diagnosis of CS.

Materials and methods: This retrospective evaluation included 145 patients with the diagnosis of CS, 119 patients with Cushing's disease (CD), and 26 patients with ACTH-independent CS (AICS), in a university hospital. Furthermore, 114 individuals in whom CS diagnosis was excluded with at least one negative screening test were enrolled to the study as control group. The clinical, laboratory, imaging, postsurgical pathologic records and also clinical follow-up data of all patients were evaluated.

Results: The median basal ACTH/cortisol ratio of the patients with CD was significantly higher than AICS and controls. A cutoff ACTH/cortisol ratio >2.5 was found to be diagnostic for CD with 82% specificity and 63% sensitivity. Among CD group, patients with recurrent disease had higher preoperative ACTH levels and ACTH/cortisol ratio than patients with sustained remission. Furthermore, these patients had more invasive, atypical, and larger tumors.

Conclusion: An ACTH/cortisol ratio >2.5 would be beneficial to diagnose CD together with other diagnostic tests. It is a simple test with no additional cost. Higher ratios might be related with larger, invasive, and atypical adenoma and also might be helpful to predict recurrence.

Keywords: Adrenocorticotropic hormone/cortisol ratio; Cushing's disease; diagnosis of Cushing's syndrome; recurrent Cushing's disease.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Receiver operating characteristic analysis of adrenocorticotropic hormone/cortisol ratio
See this image and copyright information in PMC

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