PMID- 36271288
OWN - NLM
STAT- MEDLINE
DCOM- 20221025
LR  - 20230117
IS  - 2045-2322 (Electronic)
IS  - 2045-2322 (Linking)
VI  - 12
IP  - 1
DP  - 2022 Oct 21
TI  - Usefulness of cortisol/ACTH ratio (CAR) for diagnosis of cushing's syndrome: 
      comparison of CAR with findings in dexamethasone suppression test.
PG  - 17680
LID - 10.1038/s41598-022-22676-1 [doi]
LID - 17680
AB  - Cushing's syndrome and subclinical Cushing's syndrome (SCS) are conditions of 
      increased cortisol secretion from the adrenal glands. Cushing's syndrome includes 
      adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome (Cushing's 
      disease) and ACTH-independent Cushing's syndrome (AICS). The purpose of this 
      study was to investigate the diagnostic potential of the cortisol / 
      adrenocorticotropic hormone (ACTH) ratio (CAR) for diagnosis of Cushing's 
      syndrome or SCS in adult subjects. This was a single-center, retrospective, 
      observational study. This study enrolled 44 subjects with SCS, 14 AICS, 10 CD, 
      and 248 non-Cushing's syndrome subjects who had undergone a 1 mg dexamethasone 
      suppression test (1 mg DST). Definition of SCS was as follows: no physical signs 
      characteristic of Cushing syndrome and cortisol was >/= 83 nmol/L in 1 mg DST. The 
      diagnostic potential of CAR for diagnosis of Cushing's syndrome was evaluated by 
      comparing the correlation between CAR and after-load cortisol level in 1 mg DST. 
      As the results, there was a strong positive correlation between CAR and 
      after-load cortisol level in subjects with AICS (r = 0.800, p < 0.005). CAR was 
      10,040 +/- 4170 nmol/pmol in subjects with NCS, 17,535 +/- 10,246 nmol/pmol in SCS, 
      101,221 +/- 18,009 nmol/pmol in AICS, and 4324 +/- 2051 nmol/pmol in CD, all of which 
      were significantly higher compared to those with AICS (p < 0.0005). The cutoff 
      values of CAR for screening at our institution were 11,849.6 nmol/pmol for AICS 
      (AUC 0.935, p < 0.005, sensitivity 92.3%, specificity 83.5%) and 7006.1 nmol/pmol 
      for CD (AUC 0.714, p < 0.05, sensitivity 100.0%, specificity 46.8%). There was a 
      positive correlation between CAR and adrenal adenoma diameter in subjects with 
      AICS (r = 0.508, p < 0.05), but there was no correlation between tumor diameter 
      and CAR in subjects with SCS and CD. In conclusion, high CAR indicates increased 
      cortisol secretion from the adrenal glands. Since CAR is a simple indicator that 
      can be easily evaluated by general practitioners as well as endocrinologists, we 
      think CAR would be useful for the early detection of Cushing's syndrome.
CI  - (c) 2022. The Author(s).
FAU - Iwamoto, Yuichiro
AU  - Iwamoto Y
AD  - Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, 
      577 Matsushima, Kurashiki, 701-0192, Japan.
FAU - Tatsumi, Fuminori
AU  - Tatsumi F
AD  - Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, 
      577 Matsushima, Kurashiki, 701-0192, Japan.
FAU - Itoh, Takashi
AU  - Itoh T
AD  - Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, 
      577 Matsushima, Kurashiki, 701-0192, Japan.
FAU - Sasaki, Taku
AU  - Sasaki T
AD  - Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, 
      577 Matsushima, Kurashiki, 701-0192, Japan.
FAU - Mori, Shigehito
AU  - Mori S
AD  - Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, 
      577 Matsushima, Kurashiki, 701-0192, Japan.
FAU - Sugisaki, Toshitomo
AU  - Sugisaki T
AD  - Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, 
      577 Matsushima, Kurashiki, 701-0192, Japan.
FAU - Nakao, Erina
AU  - Nakao E
AD  - Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, 
      577 Matsushima, Kurashiki, 701-0192, Japan.
FAU - Ohnishi, Mana
AU  - Ohnishi M
AD  - Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, 
      577 Matsushima, Kurashiki, 701-0192, Japan.
FAU - Kusano, Takashi
AU  - Kusano T
AD  - Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, 
      577 Matsushima, Kurashiki, 701-0192, Japan.
FAU - Takenouchi, Haruka
AU  - Takenouchi H
AD  - Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, 
      577 Matsushima, Kurashiki, 701-0192, Japan.
FAU - Iwamoto, Hideyuki
AU  - Iwamoto H
AD  - Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, 
      577 Matsushima, Kurashiki, 701-0192, Japan.
FAU - Sanada, Junpei
AU  - Sanada J
AD  - Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, 
      577 Matsushima, Kurashiki, 701-0192, Japan.
FAU - Fushimi, Yoshiro
AU  - Fushimi Y
AD  - Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, 
      577 Matsushima, Kurashiki, 701-0192, Japan.
FAU - Katakura, Yukino
AU  - Katakura Y
AD  - Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, 
      577 Matsushima, Kurashiki, 701-0192, Japan.
FAU - Kimura, Tomohiko
AU  - Kimura T
AD  - Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, 
      577 Matsushima, Kurashiki, 701-0192, Japan.
FAU - Shimoda, Masashi
AU  - Shimoda M
AD  - Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, 
      577 Matsushima, Kurashiki, 701-0192, Japan.
FAU - Nakanishi, Shuhei
AU  - Nakanishi S
AD  - Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, 
      577 Matsushima, Kurashiki, 701-0192, Japan.
FAU - Kaku, Kohei
AU  - Kaku K
AD  - Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, 
      577 Matsushima, Kurashiki, 701-0192, Japan.
FAU - Mune, Tomoatsu
AU  - Mune T
AD  - Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, 
      577 Matsushima, Kurashiki, 701-0192, Japan.
FAU - Kaneto, Hideaki
AU  - Kaneto H
AD  - Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, 
      577 Matsushima, Kurashiki, 701-0192, Japan. kaneto@med.kawasaki-m.ac.jp.
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20221021
PL  - England
TA  - Sci Rep
JT  - Scientific reports
JID - 101563288
RN  - 9002-60-2 (Adrenocorticotropic Hormone)
RN  - WI4X0X7BPJ (Hydrocortisone)
RN  - 7S5I7G3JQL (Dexamethasone)
SB  - IM
MH  - Adult
MH  - Humans
MH  - *Cushing Syndrome/diagnosis
MH  - Adrenocorticotropic Hormone
MH  - Hydrocortisone
MH  - Retrospective Studies
MH  - Dexamethasone
PMC - PMC9587020
COIS- The authors declare no competing interests.
EDAT- 2022/10/23 06:00
MHDA- 2022/10/26 06:00
PMCR- 2022/10/21
CRDT- 2022/10/22 00:11
PHST- 2022/08/21 00:00 [received]
PHST- 2022/10/18 00:00 [accepted]
PHST- 2022/10/22 00:11 [entrez]
PHST- 2022/10/23 06:00 [pubmed]
PHST- 2022/10/26 06:00 [medline]
PHST- 2022/10/21 00:00 [pmc-release]
AID - 10.1038/s41598-022-22676-1 [pii]
AID - 22676 [pii]
AID - 10.1038/s41598-022-22676-1 [doi]
PST - epublish
SO  - Sci Rep. 2022 Oct 21;12(1):17680. doi: 10.1038/s41598-022-22676-1.