New Study published by the Journal of Clinical Endocrinology & Metabolism

by Kristin

I came across an interesting new study published by the Journal of Clinical Endocrinology & Metabolism on Specificity of Screening Tests for Cushing’s Syndrome in an Overweight & Obese Population.

Widespread screening of overweight and obese adults for Cushing’s syndrome is not supported by a new study, even when one or more features of Cushing’s syndrome are present.

“Broad screening programs for Cushing’s syndrome in an obese population would likely lead to unnecessary testing, false-positive results and anxiety,” Dr. Smita K. Baid of the National Institutes of Health, Bethesda, Maryland and colleagues report in the October issue of the Journal of Clinical Endocrinology and Metabolism.

Using tests and criteria recommended by recent Endocrine Society guidelines for screening for Cushing’s syndrome, the research team “found no subject with the disorder among 369 people who were overweight or obese with a mean of five to six signs or symptoms” of the disorder, according to their report.

All subjects completed two or three tests: a 24-hour urine cortisol, and/or late-night salivary cortisol, and/or 1 mg dexamethasone suppression test (DST). An abnormal result on any of these tests triggered a repeat test and/or a dexamethasone-CRH test. Subjects with abnormal DST results and a low dexamethasone level were asked to repeat the test with 2 mg dexamethasone.

The guidelines suggest that Cushing’s syndrome should not be diagnosed unless two tests are abnormal. When the investigators applied this rule, the combined specificities of double combinations of urine free cortisol, DST, and/or salivary cortisol for excluding Cushing’s syndrome ranged from 84% to 90%. The specificity of urine free cortisol, DST and salivary cortisol together was 78%.

While roughly one fourth of the study subjects had at least one abnormal result, mean composite scores among subjects with and without test abnormalities were not significantly different, the investigators report.

This, they say, “highlights the difficulty in determining whom to screen and supports the fact that these screening tests were falsely positive.”

“We caution against a literal interpretation of the recent guidelines,” the authors write. Instead, they suggest that patients be monitored for worsening symptoms over time and then screened, if appropriate.

“Clinical judgment, taking into account the number and progression of symptoms, remains essential for the diagnosis of Cushing’s syndrome,” the researchers conclude.

Report curtosey of NEW YORK (Reuters Health)

I have mixed feelings about this study. On the one hand, I think a study like this helps to perpetuate an uphill battle many patients face in trying to get a diagnosis of Cushing’s syndrome because doctors think it’s a rare occurrence. And for doctors who’ve had little or no direct experience in diagnosing or treating a patient with Cushing’s, this study (in my opinion) may prevent exploratory testing in patients who truly need it.

On the other hand, as a society we are faced with 2 epidemics - the onset of obesity and the availability of wide spread medical information courtesy of yours truly the Internet. I think obesity & Cushing’s are mutually exclusive and are too often thought of as one in the same - because you are obese doesn’t mean you have Cushing’s and because you have Cushing’s doesn’t necessarily mean you are obese. Yes, being overweight or in some cases obese is a symptom of Cushing’s - but that’s just one symptom. I think there are other far more telling symptoms of Cushing’s besides one’s weight.

The Internet is an amazing tool (it’s hard to think about life before it) and has given us the power to do so many things, such as not taking a back seat to our health care - but rather researching & learning information as it pertains to our well-being. Having access to so much information can at times be a slippery slope because there is a small percentage of people that may have similar symptoms to that of something more serious and they use the information they find online to diagnose themselves or others around them. And all without consulting their doctor.

In my opinion, in a perfect world we’d use the Internet to empower ourselves with information pertaining to our health & body and then present our findings to our doctor to be proactive in getting to the root of what’s going wrong.

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