A Probabilistic Model for Cushing's Syndrome Screening in At-Risk Populations: A Prospective Multicenter Study
Por:
Leon-Justel, A, Madrazo-Atutxa, A, Alvarez-Rios, AI, Infantes-Fontan, R, Garcia-Arnes, JA, Lillo-Munoz, JA, Aulinas, A, Urgell-Rull, E, Boronat, M, Sanchez-de-Abajo, A, Fajardo-Montanana, C, Ortuno-Alonso, M, Salinas-Vert, I, Granada, ML, Cano, DA, Leal-Cerro, A
Publicada:
1 oct 2016
Resumen:
Context: Cushing's syndrome (CS) is challenging to diagnose. Increased prevalence of CS in specific patient populations has been reported, but routine screening for CS remains questionable. To decrease the diagnostic delay and improve disease outcomes, simple new screening methods for CS in at-risk populations are needed.
Objective: To develop and validate a simple scoring system to predict CS based on clinical signs and an easy-to-use biochemical test.
Design: Observational, prospective, multicenter.
Setting: Referral hospital.
Patients: A cohort of 353 patients attending endocrinology units for outpatient visits.
Interventions: All patients were evaluated with late-night salivary cortisol (LNSC) and a low-dose dexamethasone suppression test for CS.
Main Outcome Measures: Diagnosis or exclusion of CS.
Results: Twenty-six cases of CS were diagnosed in the cohort. A risk scoring system was developed by logistic regression analysis, and cutoff values were derived from a receiver operating characteristic curve. This risk score included clinical signs and symptoms (muscular atrophy, osteoporosis, and dorsocervical fat pad) and LNSC levels. The estimated area under the receiver operating characteristic curve was 0.93, with a sensitivity of 96.2% and specificity of 82.9%.
Conclusions: We developed a risk score to predict CS in an at-risk population. This score may help to identify at-risk patients in non-endocrinological settings such as primary care, but external validation is warranted.
Filiaciones:
Leon-Justel, A:
Univ Seville, Huelva Univ Hosp, Hosp Univ Virgen del Rocio, Consejo Super Invest Cient,Inst Biomed Sevilla,Me, Seville 41013, Spain
Madrazo-Atutxa, A:
Univ Seville, Hosp Univ Virgen del Rocio, Consejo Super Invest Cient, IBiS,Unidad Gest Clin Endocrinol & Nutr, Seville 41013, Spain
Alvarez-Rios, AI:
Univ Seville, Virgen del Rocio Univ Hosp, IBiS, CSIC,SAS,Dept Clin Biochem, Seville 41013, Spain
Infantes-Fontan, R:
Hosp Univ Virgen del Rocio, Secc Hormonas Especiales, Serv Bioquim, Seville 41013, Spain
Garcia-Arnes, JA:
Carlos Haya Hosp, Dept Clin Endocrinol & Nutr, Malaga 29010, Spain
Lillo-Munoz, JA:
Hosp Reg Univ Malaga, Malaga 29010, Spain
Aulinas, A:
Univ Autonoma Barcelona, Hosp St Pau, Dept Endocrinol Med, Pituitary Dis Res Grp, Barcelona 08025, Spain
ISCIII, CIBERER U747, Barcelona 08025, Spain
Urgell-Rull, E:
Hosp Santa Creu & Sant Pau, Dept Clin Biochem, Barcelona 08025, Spain
Boronat, M:
Univ Las Palmas Gran Canaria, Hosp Univ Insular, Inst Univ Invest Biomed & Sanitarias, Secc Endocrinol & Nutr, Las Palmas Gran Canaria 35001, Spain
Sanchez-de-Abajo, A:
Hosp Univ Insular Gran Canaria, Serv Bioquim Clin, Las Palmas Gran Canaria 35016, Spain
Fajardo-Montanana, C:
Hosp Univ La Ribera, Valencia 46600, Spain
Ortuno-Alonso, M:
Hosp Univ La Ribera, Valencia 46600, Spain
Salinas-Vert, I:
Hosp Badalona Germans Trias & Pujol, Serv Endocrinol & Nutr, Barcelona 08916, Spain
Granada, ML:
Hosp Badalona Germans Trias & Pujol, Serv Bioquim, Barcelona 08916, Spain
Cano, DA:
Univ Seville, Hosp Univ Virgen del Rocio, Consejo Super Invest Cient, IBiS,Unidad Gest Clin Endocrinol & Nutr, Seville 41013, Spain
Leal-Cerro, A:
Univ Seville, Hosp Univ Virgen del Rocio, Consejo Super Invest Cient, IBiS,Unidad Gest Clin Endocrinol & Nutr, Seville 41013, Spain
Bronze, Green Published
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