The DOI matches its Crossref record; 51 of the 54 references it cites were found in a registry or an index.
Accuracy of Diagnostic Tests for Cushing’s Syndrome: A Systematic Review and Metaanalyses
Abstract
Context: The diagnosis of Cushing’s syndrome (CS) requires the use of tests of unregulated hypercortisolism that have unclear accuracy. Objective: Our objective was to summarize evidence on the accuracy of common tests for diagnosing CS. Data Sources: We searched electronic databases (MEDLINE, EMBASE, Web of Science, Scopus, and citation search for key articles) from 1975 through September 2007 and sought additional references from experts. Study Selection: Eligible studies reported on the accuracy of urinary free cortisol (UFC), dexamethasone suppression test (DST), and midnight cortisol assays vs. reference standard in patients suspected of CS. Data Extraction: Reviewers working in duplicate and independently extracted study characteristics and quality and data to estimate the likelihood ratio (LR) and the 95% confidence interval (CI) for each result. Data Synthesis: We found 27 eligible studies, with a high prevalence [794 (9.2%) of 8631 patients had CS] and severity of CS. The tests had similar accuracy: UFC (n = 14 studies; LR+ 10.6, CI 5.5–20.5; LR− 0.16, CI 0.08–0.33), salivary midnight cortisol (n = 4; LR+ 8.8, CI 3.5–21.8; LR− 0.07, CI 0–1.2), and the 1-mg overnight DST (n = 14; LR+ 16.4, CI 9.3–28.8; LR− 0.06, CI 0.03–0.14). Combined testing strategies (e.g. a positive result in both UFC and 1-mg overnight DST) had similar diagnostic accuracy (n = 3; LR+ 15.4, CI 0.7–358; LR− 0.11, CI 0.007–1.57). Conclusions: Commonly used tests to diagnose CS appear highly accurate in referral practices with samples enriched with patients with CS. Their performance in usual clinical practice remains unclear.
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“When the assay upper limit of normal is used as a criterion, the overall evidence supports the diagnostic accuracy of UFC in adults suspected of having Cushing's syndrome (2,51).”
From The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline. (2008) · cites this paper as [2]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The four recommended tests have acceptable diagnostic accuracy when the suggested cutoff points are used (2,30).”
From The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline. (2008) · cites this paper as [2]
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“Overall, the evidence in adults suggests that the accuracy of this test is similar to that of UFC (2).”
From The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline. (2008) · cites this paper as [2]
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“Overall, the evidence in adults indicates that in studies with low prevalence of Cushing's syndrome this test has similar performance as the others recommended for initial testing (2).”
From The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline. (2008) · cites this paper as [2]
In the citing paper
“LNSC is emerging as perhaps the most accurate test in diagnosing overt Cushing’s syndrome (240), but for ACS the published studies have given mixed results. In some cases, sensitivity reached 93.8%, but with relatively poor specificity at 79.5% (227) (Table 6).”
From Adrenal incidentaloma (2020) · cites this paper as [240]
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Citations
Cites
Measuring inconsistency in meta-analyses
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Interaction revisited: the difference between two estimates.
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The diagnostic odds ratio: a single indicator of test performance
Glas, A. S., Lijmer, J. G., Prins, M. H., Bonsel, G. J., & Bossuyt, P. M. M. (2003) · Journal of Clinical Epidemiology · doi:10.1016/s0895-4356(03)00177-x · Cited by 2,261
Meta-DiSc: a software for meta-analysis of test accuracy data
Zamora, J., Abraira, V., Muriel, A., Khan, K. S., & Coomarasamy, A. (2006) · BMC Medical Research Methodology · doi:10.1186/1471-2288-6-31 · Cited by 1,884
Lacroix, A., Feelders, R. A., Stratakis, C. A., & Nieman, L. K. (2015) · The Lancet · doi:10.1016/s0140-6736(14)61375-1 · Cited by 1,777
Diagnosis and complications of Cushing’s syndrome: a consensus statement
Arnaldi, G., Angeli, A., Atkinson, A. B., Bertagna, X., Cavagnini, F., Chrousos, G. P., Fava, G. A., Findling, J. W., Gaillard, R. C., Grossman, A. B., et al. (2003) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2003-030871 · Cited by 1,362
Systematic reviews of evaluations of diagnostic and screening tests
Deeks, J. J. (2001) · BMJ · doi:10.1136/bmj.323.7305.157 · Cited by 1,345
Newell-Price, J. D. C., BERTAGNA, X. Y., Grossman, A. B., & Nieman, L. K. (2006) · The Lancet · doi:10.1016/s0140-6736(06)68699-6 · Cited by 1,258
Flagged first, then by citations
3 of the 54 references couldn’t be matched to a known paper.
Research works printed but not linked: 1
- Montori, 2003, Evidence-based medicine and the diagnostic process, In: Price C, Christenson R, eds. Evidence-based laboratory medicine. Washington, DC: AACC Press;, 1
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Sorted by citations
Items 201–222 of 222
Overview and Initial Management of Cushing Syndrome
Youssef, S., & Singhal, V. (2020) · Springer eBooks · doi:10.1007/978-3-030-52215-5_50
Balentine, C. J., & Sippel, R. S. (2015) · Springer eBooks · doi:10.1007/978-3-319-13662-2_35
Subklinischer) Hyperkortisolismus als mögliche endokrine Hypertonieursache
Stepan, V. M. (2013)
Clinical, Laboratory, and Radiological Diagnosis of Hypercortisolism
Guido, P., & Zamora, C. A. (2022) · Springer eBooks · doi:10.1007/978-3-030-87189-5_4
(2009) · Current Opinion in Endocrinology Diabetes and Obesity · doi:10.1097/med.0b013e32832eb365
(2009) · Current Opinion in Obstetrics & Gynecology · doi:10.1097/gco.0b013e32832f731f
Stewart, A. A., & Story, E. S. (2017) · Wiley eBooks · doi:10.1002/9781119196235.ch47
Moalem, J., Suh, I., & Duh, Q. (2009) · Cancer treatment and research · doi:10.1007/978-1-4419-0857-5_8
Maghnie, M., Secco, A., & Loche, S. (2008) · KARGER eBooks · doi:10.1159/000158554
Badakhshi, H. (2016) · Springer eBooks · doi:10.1007/978-3-319-39189-2_9
Yamada, H. (2016) · Springer eBooks · doi:10.1007/978-3-662-47398-6_118
Pereira, A. M., & Dekkers, O. M. (2022) · Elsevier eBooks · doi:10.1016/b978-0-323-99899-4.00006-8
Honour, J. W. (2023) · Elsevier eBooks · doi:10.1016/b978-0-12-818124-9.00019-x
Adrenal Multidisipliner Güncel Yaklaşım
Özen, F. Z., Özer, M., Özsoy, Ç., Binnetoğlu, E., Alparslan, A. Ş., Budak, E. S., Kök, E. V., Çetinkaya, G. S., Durmuş, M. E., Köker, G., et al. (2024) · Akademisyen Kitabevi eBooks · doi:10.37609/akya.2992
Pituitary tumors, ACTH-secreting
Pivonello, R., Larocca, A., Simeoli, C., Paola, N. D., Crescenzo, E. M., & Colao, A. (2024) · Elsevier eBooks · doi:10.1016/b978-0-443-13825-6.00122-9
ACTH-dependent Cyclic Cushing Syndrome With Successful Pregnancy and Early Postpartum Relapse
Diah, M. I. M., Ho, J. H., & Tee, H. C. (2025) · JCEM Case Reports · doi:10.1210/jcemcr/luaf079
Cushing’s syndrome due to Carney complex in two siblings
Bhandarkar, A. P., Samaga, L., Acharya, S. V., Bonigi, S., & Nagendra, L. (2025) · BMJ Case Reports · doi:10.1136/bcr-2024-264760
Lee, J., Fukuoka, H., Park, S. S., Hong, A. R., Kim, J. H., Chin, S. O., Baek, H.-S., Lim, D., Kageyama, K., Nishiyama, M., et al. (2026) · Endocrinology and Metabolism · doi:10.3803/enm.2025.2707
Absent nocturnal cortisol decline in Pheochromocytoma: A retrospective study
Sun, Y., Kometani, M., Aiga, K., Mai, X., Konishi, S., Kadono, M., Gondoh, Y., & Yoneda, T. (2026) · Steroids · doi:10.1016/j.steroids.2026.109779
Chasseloup, F. (2022) · theses.fr (ABES) · doi:10.70675/ddec5b6dzf376z4aadz9970zf0bf052c6f02
Matteotti, R., Milone, L., Canter, D. J., & Gagner, M. (2011) · Springer eBooks · doi:10.1007/978-3-540-45021-4_29
(2010) · PubMed · Cited by 139
Metadata
- Authors
- Elamin, M. B., Murad, M. H., Mullan, R., Erickson, D., Harris, K., Nadeem, S., Ennis, R., Erwin, P. J., & Montori, V. M.
- Affiliations
- Mayo Clinic (US)
- Department of Medicine (M.H.M., D.E., K.H., R.E., V.M.M.), Mayo Clinic, Rochester, Minnesota 55905
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2008-05-01
- Volume
- 93
- Issue
- 5
- Pages
- 1553-1562
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2082303249
- Cited by
- 222
- References
- 54
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 6 · 2023: 7 · 2022: 12 · 2021: 6 · 2020: 15 · 2019: 10 · 2018: 10 · 2017: 17 · 2016: 22 · 2015: 12 · 2014: 10 · 2013: 17 · 2012: 13
- FWCI
- 2.68
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Keywords
- Cushing's syndrome, diagnostic accuracy, urinary free cortisol, dexamethasone suppression test, hypercortisolism, likelihood ratios, combined diagnostic testing
- MeSH terms
- Cushing Syndrome, Dexamethasone, Humans, Hydrocortisone
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