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Human corticotropin-releasing hormone tests: 10 years of real-life experience in pituitary and adrenal disease

Journal of Clinical Endocrinology & Metabolism Sep 24, 2020

Ceccato F, Tizianel I, Vedolin CK, et al. - Researchers evaluated the diagnostic accuracy of the hCRHtest [human corticotropin-releasing hormone (CRH) test] which is employed to distinguish Cushing disease (CD) from ectopic adrenocorticotropin (ACTH) secretion (EAS), to evaluate autonomous cortisol secretion by the adrenal glands as well as to characterize pseudo-Cushing syndrome (CS) or adrenal insufficiency. In this cross-sectional study, ACTH and cortisol levels were recorded; the peak values (peakACTH and peakcortisol) were obtained, and the percentage rises (∆%ACTH and ∆%cortisol) following an intravenous bolus of 100 μg hCRH were computed. This analysis involved 200 patients. In CD, higher peakACTH and peakcortisol were detected, and ∆%ACTH and ∆%cortisol enabled the differentiation of CD from EAS with a sensitivity and specificity more than 80%. Based on the findings, experts concluded hCRHtest test to be the mainstay of the differential diagnosis of ACTH-dependent CS. They also suggested its worth for pointing to a diagnosis of CD in the event of bilateral adrenal masses, as well as in patients exhibiting low basalACTH.

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