The Importance of DHEA-S Levels in Cushing's Syndrome; Is There a Cut-off Value in the Differential Diagnosis?


Ciftci S., Soyluk O., SELEK A., Erol S., HEKİMSOY Z., Esen A., ...More

HORMONE AND METABOLIC RESEARCH, vol.54, no.04, pp.232-237, 2022 (Journal Indexed in SCI) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 54 Issue: 04
  • Publication Date: 2022
  • Doi Number: 10.1055/a-1783-7901
  • Title of Journal : HORMONE AND METABOLIC RESEARCH
  • Page Numbers: pp.232-237
  • Keywords: Cushing's disease, adrenal Cushing's syndrome, ectopic ACTH syndrome, dehydroepiandrosterone-sulfate, DHEA-S cut-off, differential diagnosis, DEHYDROEPIANDROSTERONE-SULFATE, ADRENAL ANDROGEN, ACTH, SECRETION, CORTISOL, DISSOCIATION, RECURRENCE, DISEASE, TUMOR

Abstract

The purpose of this study was to determine possible cut-off levels of basal DHEA-S percentile rank in the differential diagnosis of patients with Cushing's syndrome (CS) with ACTH levels in the gray zone and normal DHEA-S levels. In this retrospective study including 623 pathologically confirmed CS, the DHEA-S percentile rank was calculated in 389 patients with DHEA-S levels within reference interval. The patients were classified as group 1 (n=265 Cushing's disease; CD), group 2 (n=104 adrenal CS) and group 3 (n=20 ectopic ACTH syndrome).ROC-curve analyses were used to calculate the optimal cut-off level of DHEA-S percentile rank in the reference interval in the differential diagnosis of CS, and the effectiveness of this cut-off level in the identification of the accurate etiology of CS was assessed in patients who were in gray zone according to their ACTH levels. The DHEA-S percentile rank in the reference interval were significantly lower in group 2 compared to the other two groups (p<0.001), while group 1 and group 3 had similar levels. The optimal cut-off level of DHEA-S percentile rank in the reference interval providing differential diagnosis between group 1 and group 2 was calculated as 19.5th percentile (80.8% sensitivity, 81.5% specificity) and the level demonstrated the accurate etiology in 100% of CD and 76% of adrenal CS patients who were in the gray zone. This study showed that the cut-off value of DHEA-S level less than 20% of the reference interval could be used for differential diagnosis of CD and adrenal CS with high sensitivity and specificity, and it should be taken into the initial evaluation.