The Utility of Preoperative ACTH/Cortisol Ratio for the Diagnosis and Prognosis of Cushing's Disease

Abstract

Purpose:Cushing's syndrome (CS) is a rare disease having diagnostic difficulties. Many diagnostic tests have been defined but none of these are diagnostic alone. Determination of the cause is another problem which sometimes requires more sophisticated and invasive procedures. Therefore, we aimed to evaluate the utility of pretreatment plasma adrenocorticotropic hormone (ACTH)/cortisol ratios in patients with confirmed endogenous CS for the diagnosis and differential diagnosis of CS.Materials and Methods:This retrospective evaluation included 145 patients with the diagnosis of CS, 119 patients with Cushing's disease (CD), and 26 patients with ACTH-independent CS (AICS), in a university hospital. Furthermore, 114 individuals in whom CS diagnosis was excluded with at least one negative screening test were enrolled to the study as control group. The clinical, laboratory, imaging, postsurgical pathologic records and also clinical follow-up data of all patients were evaluated.Results:The median basal ACTH/cortisol ratio of the patients with CD was significantly higher than AICS and controls. A cutoff ACTH/cortisol ratio >2.5 was found to be diagnostic for CD with 82% specificity and 63% sensitivity. Among CD group, patients with recurrent disease had higher preoperative ACTH levels and ACTH/cortisol ratio than patients with sustained remission. Furthermore, these patients had more invasive, atypical, and larger tumors.Conclusion:An ACTH/cortisol ratio >2.5 would be beneficial to diagnose CD together with other diagnostic tests. It is a simple test with no additional cost. Higher ratios might be related with larger, invasive, and atypical adenoma and also might be helpful to predict recurrence.

Adrenocorticotropin/cortisol ratio – a marker of psoriasis severity

“…Adrenocorticotropin/cortisol ratio was not previously evaluated in patients with psoriasis, but has been reported in other medical problems, such as the Cushing syndrome diagnostic test, viral infections, sepsis and psychoneurological studies [8][9][10][11]. Our analysis showed that ACTH/cortisol ratio correlates with the severity of psoriasis and can be possibly utilized as a biochemical marker of disease severity.…”

Adrenocortical System Hormones in Non-Critically ill Covid-19 Patients

“…As shown in Figure 1, the difference in median cortisol /ACTH ratio is more prominent than in the others. Using the ratio of cortisol/ACTH in the diagnosis of primary hypoadrenalism and/or Cushing's disease is suggested by some investigators (17,18). So, using this ratio in future similar studies of COVID-19 infected patients would add more information on the effect of this disease on the hypothalamic-adrenocortical axis.…”

Hypercortisolemia Recurrence in Cushing's Disease; a Diagnostic Challenge

“…In another study, preoperative ACTH and ACTH/cortisol ratio were significantly higher in patients who experienced recurrence as compared to patients with sustained remission (43). Conversely, in another study all postoperative patients who later experienced recurrence had an ACTH value >20 ng/l and all those with sustained remission had <20 ng/l, with a statistically significant difference (44).…”

“…The role of ACTH in diagnosing either remission or recurrence is controversial. Adrenocorticotropic hormone has been studied as a predictor for remission and prognosis of recurrence following TSS for CD, either measured before treatment (42, 43), perioperatively (44), or during the immediate postoperative period (26, 45). These studies were performed with ACTH levels alone, in conjunction with dehydroepiandrosterone (DHEA) and DHEA sulfate (DHEAS), ACTH to cortisol ratio, or ACTH following suppression with betamethasone.…”