Evaluation of the diagnostic criteria for Cushing’s disease in Japan [Review]

Endocrine Journal

Ken Terui³  Takeshi Nigawara³  Toshihiro Suda¹  Kazunori Kageyama³  Satoru Sakihara³  Yutaka Oki² 

[1] Aomori Rosai Hospital, Hachinohe 031-8551, Japan;Second Division, Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Japan;Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan

关键词: ACTH;    Cortisol;    Cushing’s disease;    Pituitary;    Ectopic ACTH syndrome;   

DOI  :  10.1507/endocrj.EJ12-0299

学科分类：内分泌与代谢学

来源: Japan Endocrine Society

【 摘 要 】

References(38)Cited-By(12)Adrenocorticotropic hormone (ACTH)-dependent Cushing’s syndrome is caused by an ACTH-producing tumor, as is the case with Cushing’s disease and ectopic ACTH syndrome (EAS).Diagnosis and differential diagnosis of Cushing’s disease from EAS in ACTH-dependent Cushing’s syndrome are thus challenging problems in clinical endocrinology.The diagnostic criteria for Cushing’s disease in Japan, established by the working group of the Japan Ministry of Health, Labour and Welfare, were originally reported in 2003 and revised in 2007 and 2010.In addition, criteria for subclinical Cushing’s disease were established in Japan in 2010.In this review, we evaluate the usefulness and accuracy of the most recent diagnostic criteria.Previous data suggest that as an initial test of Cushing’s syndrome, 0.5 mg dexamethasone is more sensitive than 1 mg in the overnight dexamethasone suppression test (DST).Here, we recommend 0.5 mg plus a plasma cortisol cut-off level of 3 μg/dL as a suitable low-dose overnight DST for screening of all cases of ACTH-dependent Cushing’s syndrome in Japan.Recently, standardization of cortisol measurements by the ID-LC/MS/MS method using seven assay kits with standard plasma material containing synthetic hydrocortisone-d4 was carried out in Japan.The resulting relative standard deviation was within 10%.The cut-off value remains valid even after standardization of plasma cortisol measurements.Although the recent diagnostic criteria achieve higher diagnostic specificity, care should be taken since data for Cushing’s disease partially overlaps with some cases of EAS.Overall, therefore, this review suggests that the accuracy of each diagnostic test should be considered.

【 授权许可】

Unknown