Table 3.
Management of hypercortisolism and Cushing’s syndrome according to prevalent medical specialty
| Prevalent Specialty (n of centers) | Internal Medicine (n = 36) | Cardiology (n = 25) | Others* (n = 21) | P-value |
|---|---|---|---|---|
| (6) In which group of patients, you request the evaluation of 24 h urinary free cortisol or the overnight 1-mg dexamethasone suppression test if not performed before? | ||||
| (a) Patients with hypertension and specific features (buffalo hump, moon facies, purple reddish striae) | 28 (77.8) | 17 (68.0) | 18 (85.7) | 0.360 |
| (b) All patients with diabetes and hypertension | 4 (11.1) | 0 (0.0) | 2 (9.5) | 0.228 |
| (c) All patients with hypertension and adrenal mass | 28 (77.8) | 9 (36.0) | 18 (85.7) | < 0.001 |
| (d) All patients with hypertension and obesity | 6 (16.7) | 1 (4.0) | 2 (9.5) | 0.322 |
| (e) All patients with hypertension and obesity and adrenal mass | 15 (41.7) | 8 (32.0) | 8 (38.1) | 0.805 |
| (f) All patients with resistant hypertension | 28 (77.8) | 9 (36.0) | 13 (61.9) | 0.004 |
| (g) All patients with hypertension aged less than 50 years | 12 (33.3) | 8 (32.0) | 6 (28.6) | 0.932 |
| (h) When the phenotype is suspect, I refer the patient to an endocrinologist | 4 (11.1) | 8 (32.0) | 1 (4.8) | 0.034 |
| (7) Which test(s) do you perform for screening of hypercortisolism? | ||||
| (a) 1-mg overnight dexamethasone suppression test | 22 (61.1) | 8 (32.0) | 10 (47.6) | 0.003 |
| (b) 24 h urinary free cortisol | 24 (66.7) | 15 (60.0) | 15 (71.4) | 0.712 |
| (c) Late night salivary cortisol | 2 (5.6) | 4 (16.0) | 3 (14.3) | 0.358 |
| (d) Basal cortisol and ACTH | 22 (61.1) | 12 (48.0) | 10 (47.6) | 0.052 |
| (e) Adrenal CT scanning or MRI | 6 (16.7) | 2 (8.0) | 2 (9.5) | 0.687 |
| (f) I refer to the endocrinologist without performance of any test | 2 (5.6) | 7 (28.0) | 1 (4.8) | 0.020 |
| (8) Are you aware of a referral centre in your area with expertise of Cushing syndrome management? | ||||
| (a) Yes | 30 (83.3) | 13 (52.0) | 14 (66.7) | 0.031 |
| (b) No | 6 (16.7) | 12 (48.0) | 7 (33.3) | |
| (9) How do you consider a patient with a level of cortisol of 2.5 μg/dL at 8 a.m. after overnight 1-mg dexamethasone suppression test? | ||||
| (a) Positive | 5 (13.9) | 3 (12.0) | 4 (19.0) | 0.852 |
| (b) Negative | 1 (2.8) | 1 (4.0) | 2 (9.5) | 0.681 |
| (c) Grey zone, I request further tests | 21 (58.3) | 4 (16.0) | 8 (38.1) | 0.004 |
| (d) I refer to an endocrinologist | 9 (25.0) | 17 (68.0) | 7 (33.3) | 0.003 |
Responses to questions 6–9 of the questionnaire after stratification for prevalent medical specialty. Data are reported as absolute numbers and frequencies, as appropriate. *Others: endocrinology, nephrology, geriatrics. P-value < 0.05 were considered significant and highlighted in bold