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Horm Metab Res 2022; 54(04): 232-237
DOI: 10.1055/a-1783-7901
Original Article: Endocrine Care

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

Sema Ciftci 
1   Department of Endocrinology and Metabolsim, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
,
Ozlem Soyluk
2   Department of Endocrinology and Metabolism, Istanbul University, Fatih, Turkey
,
Alev Selek
3   Department of Endocrinology and Metabolism, Kocaeli University, Kocaeli, Turkey
,
Selvinaz Erol
4   Department of Endocrinology and Metabolism, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
,
Zeliha Hekimsoy
5   Endocrinology, Celal Bayar University, Manisa, Turkey
,
Ayse Esen
1   Department of Endocrinology and Metabolsim, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
,
Huseyin Dursun
6   Department of Endocrinology and Meatbolism, Erciyes University School of Medicine, Kayseri, Turkey
,
Serdar Sahin
7   Department of Endocrinology and Metabolism, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
,
Gonca Oruk
8   Department of Endocrinology and Metabolism, Izmir Ataturk Training and Research Hospital, Izmir, Turkey
,
Meral Mert
1   Department of Endocrinology and Metabolsim, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
,
Huseyin Soylu
9   Department of Endocrinology and Metabolism, Ondokuz Mayis University, School of Medicine, Samsun, Turkey
,
Banu Sarer Yurekli
10   Department of Endocrinology and Metabolism, Ege University Faculty of Medicine, Izmir, Turkey
,
Melek Eda Ertorer
11   Department of Endocrinology and Metabolism, Baskent University Faculty of Medicine, Adana, Turkey
,
Tulay Omma
12   Department of Endocrinology and Metabolism, Ankara Training and Research Hospital, Ankara, Turkey
,
Mehtap Evran
13   Department of Endocrinology and Metabolism, Çukurova University Medical Faculty, Adana, Turkey
,
Mine Adas
14   Department of Endocrinology and Metabolism, University of Health Sciences, Okmeydani Training and Research Hospital, Istanbul, Turkey
,
Seher Tanrikulu 
15   Department of Endocrinology and Metabolsim, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
,
Kadriye Aydin
16   Department of Endocrinology and Metabolism, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
,
Zafer Pekkolay
17   Department of Endocrinology and Metabolism, Dicle Faculty of Medicine, Diyarbakır, Turkey
,
Bülent Can 
18   Department of Endocrinology and Metabolism, Istanbul Medeniyet University Faculty of Medicine, İstanbul, Turkey
,
Ersen Karakilic
19   Department of Endocrinology and Metabolism, Canakkale Onsekiz Mart University Medical Faculty, Çanakkale, Turkey
,
Zuleyha Karaca
6   Department of Endocrinology and Meatbolism, Erciyes University School of Medicine, Kayseri, Turkey
,
Habib Bilen
20   Department of Endocrinology and Metabolism, Ataturk University Faculty of Medicine, Ezurum, Turkey
,
Zeynep Canturk
3   Department of Endocrinology and Metabolism, Kocaeli University, Kocaeli, Turkey
,
Berrin Cetinarslan
3   Department of Endocrinology and Metabolism, Kocaeli University, Kocaeli, Turkey
,
Pinar Kadioglu
7   Department of Endocrinology and Metabolism, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
,
Sema Yarman
2   Department of Endocrinology and Metabolism, Istanbul University, Fatih, Turkey
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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.

Key words

Cushing’s disease - adrenal Cushing’s syndrome - ectopic ACTH syndrome - dehydroepiandrosterone-sulfate - DHEA-S cut-off - differential diagnosis


Publication History

Received: 09 January 2022

Accepted after revision: 22 February 2022

Article published online:
12 April 2022

© 2022. Thieme. All rights reserved.

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