Table 6.
Clinical characteristics and biochemical data of 15 patients with unconfirmed CD
| # (Year) | Age, sex | Signs and symptoms | UFC LC-MS/MS | LNSC LC-MS/MS | Cortisol after 1-mg DST | ACTH | MRI | Localizing studies | Pathology |
|---|---|---|---|---|---|---|---|---|---|
| 1 (2008) |
51 F | WG (+40 lb/2 y), HTN, facial plethora, dorsocervical/ supraclavicular fat | 1/7: 135.0 |
0/2 | 1.04 | 1/5: 75 |
Neg | Postop IPSS with oCRH: Peak ACTH petrosal to peripheral ratio: 8.5 at 10 min; max basal ACTH: 69 pg/mL; max ACTH value: 357 pg/mL |
Normal pituitary |
| 2 (2009) | 21 M | WG (+60 lb/3 y), fatigue, abdominal striae, depression | 1/3: 66.8 |
0/2 | 4.3 0.5 |
1/3: 46 |
6 mm | Postoperative IPSS with oCRH: Peak ACTH petrosal to peripheral ratio: 17.5 at 5 min; Max basal ACTH: 14 pg/mL; Max ACTH value: 211 pg/mL |
RCC |
| 3 (2010) | 34 F | WG (+80 lb/4 y), HTN, DM, abdominal striae | 5/10: 82.2a 108.8vs 109.0a 143.1a 114.0a |
1/6: 0.240 |
5.0 17.0 20.0 21.0 12.0 |
0/1 | 3 mm | None | Prolactinoma |
| 4 (2011) | 29 F | WG (+80 lb/5 y), irregular menses | 2/2: 103.0a 78.9a |
Not done | 31.0 | 1/1: 132 |
3 mm | Postoperative IPSS with oCRH: peak ACTH petrosal to peripheral ratio: 17.3 at 10 min; max basal ACTH: 22 pg/mL; max ACTH value: 104 pg/mL |
Normal pituitary |
| 5 (2012) | 20 F | WG (+40 lb/3 y), irregular menses, fatigue, hirsutism, abdominal striae, anxiety | 3/8: 91.0 88.0 68.0 |
1/7: 0.120 |
Not done | 1/4: 45 |
Neg | None | Normal pituitary |
| 6 (2013) | 62 F | WG (+120 lb/6 y, BMI 43.8 kg/m2), HTN, proximal myopathy, osteoporosis, abdominal striae | 2/4: 67.1a 124.3a |
0/1 | Not done | 4/7: 48 49 49 77 |
Neg | IPSS with oCRH: peak ACTH petrosal/peripheral ratio: 24 at 8 min; max basal ACTH: 355 pg/mL Max ACTH value 1120 pg/mL |
Normal pituitary |
| 7 (2013) | 52 M | HTN, decreased libido, muscle wasting, fatigue, easy bruising, depression | 4/5: 131.4 102.3 71.5 56.7 |
0.170 | Not done | 1/2: 37 |
2 mm | None | Normal pituitary |
| 8 (2014) | 45 F | WG (+40 lb/4 y, BMI 28.2 kg/m2), irregular menses, fatigue, depression | 5/21: 62.7 64.4 68.7 154.6 68.2 |
5/6: 0.18 0.16 0.10 0.09 0.51 |
0.5 | 0/3 | Neg | IPSS with DDAVP: peak ACTH petrosal/peripheral ratio: 21 at 2 min Max basal ACTH: 29 pg/mL Max ACTH value 211 pg/mL |
Normal pituitary |
| 9 (2015) |
39 F | WG (+50 lb/several months, BMI 43.62 kg/m2), HTN, fatigue, hirsutism, easy bruising, depression | 4/4: 51.0 116.0 130.0 64.0 |
4/6: 0.148 5.984 0.262 0.852 |
21.0 25.4 12.0 11.0 8.0 |
2/3 | 4 mm | None | Fibrotic tissue |
| 10 (2016) | 20 F | WG (+60 lb/1.5 y, BMI 36.75 kg/m2), irregular menses, fatigue, hirsutism, abdominal striae, easy bruising, depression | 0/4 | 1/18: 0.090 |
0.6 | 2/4 45 252.7 |
Neg | DDAVP stimulation test: negative for CD | Normal pituitary |
| 11 (2017) | 59 F | WG (+100 lb/8 y, BMI 36.64 kg/m2), HTN, DM, irregular menses, myopathy, fatigue, osteoporosis, easy bruising, depression, anxiety | 1/6: 127.0 |
0/7 | Not done | 3/10: 72 199 140 |
4 mm | None | Pituitary cyst |
| 12 (2017) | 69 F | Fatigue, easy bruising, anxiety | 4/4: 67.3a 114.6a 123.2a 105.3a |
Not done | Not done | 2/3: 40 33 |
6 mm; pituitary cyst | None | Pituitary cyst |
| 13 (2017) |
43 F | WG (60 lb/2 y, BMI 34.7), DM, fatigue, abdominal striae, anxiety | 3/4: 54.2 50.2 70.0 |
1/1: 0.120 |
Not done | 1/5: 43 |
2 mm | None | Normal pituitary |
| 14 (2019) | 33 F | WG (10 y, BMI 42.61 kg/m2), HTN, DM, irregular menses, fatigue, hirsutism, anxiety | 3/4: 71.0 93.0 57.0 |
1/1: 0.119 |
10.35 | 2/3: 33 37 |
4.5 mm | None | Normal pituitary |
| 15 (2019) |
28 F | WG (30 lb/2 y, BMI 30.2 kg/m2), irregular menses, abdominal striae, easy bruising | 1/3: 64.8 |
2/7: 0.110 0.130 |
Not done | 1/3: 85.9 |
2 mm | None | Normal pituitary |
For biochemical data, where multiple results were available, the number of abnormal values out of the total is shown (n/T), followed by the abnormal results. Reference range: UFC by LC-MS/MS was 4-50 mcg/24 h; LNSC by LC-MS/MS: <0.09 µg/dL; DST (1 mg): normal <1.8 mcg/dL. ACTH: all values ≥20 pg/mL are noted.
Abbreviations: BMI, body mass index; CD, Cushing disease; DM, diabetes mellitus; F, female; HTN, hypertension; IPSS, inferior petrosal sinus sampling; LC-MS/MS, liquid chromatography tandem mass spectometry; LNSC, late night salivary cortisol; MRI, magnetic resonance imaging; M, male; Neg, negative; oCRH, ovine corticotropin releasing hormone; RCC, Rathke cleft cyst; UFC, 24-h urinary free cortisol; WG, weight gain.
a Unknown assay methodology. The fraction of elevated values is shown for each patient for UFC, LNSC, and ACTH.