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justashell

From Vanderbilt University Pituitary Center

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I don't know how "news-ish" this really is, but was surfing around and saw it:

 

A new test reliably distinguishes between patients with mild Cushing's syndrome, pseudo-Cushing's states, and normal individuals. Yanovski and others from the National Institutes of Health [J Clin Endocrinol Metab 83:348-352,1998] have reported results of studies employing the dexamethasone-suppressed corticotropin-releasing hormone stimulation test in normal volunteers and patients with mild Cushing's disease. A cortisol level obtained 15 minutes after the administration of corticotropin-releasing hormone was more accurate in the diagnosis of Cushing's disease than basal urine studies and dexamethasone- suppressed urine cortisol levels. This test seems useful in the evaluation of patients with suspected Cushing's syndrome that have normal or minimally elevated urinary steroid levels.

 

http://www.pituitarycenter.com/site/whatsnew.php#cush

 

Input from those of you who are "up to date" on the efficacy of tests is greatly appreciated.

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Shelley,

I am pretty sure this is the CRH/DEX test. It is only useful if you are in a high at the time of that test. The test was very promising when it was introduced, unfortunately it is missing many people who do have cushings. There are members on here that failed the test and passed another time when they had it. I can think of two ladies that this happened to. They had the CRH/DEX test, failed it and then passed it a short time later. I can think of many more who had that test and failed it but they have since been diagnosed with cushings. However, if you have that test and pass the test, than you 100% have cushings.

Kate G

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Shelley,

I am pretty sure this is the CRH/DEX test. It is only useful if you are in a high at the time of that test. The test was very promising when it was introduced, unfortunately it is missing many people who do have cushings. There are members on here that failed the test and passed another time when they had it. I can think of two ladies that this happened to. They had the CRH/DEX test, failed it and then passed it a short time later. I can think of many more who had that test and failed it but they have since been diagnosed with cushings. However, if you have that test and pass the test, than you 100% have cushings.

Kate G

 

 

My cortisol stayed suppressed with that one from 0.5 to 0.6, 0.5, .05 and 0.6 at 15 minute intervals after injection, and after 48 hours of 0.5mg q 6 hours dexamethasone.

I did, however have a 7.6 midnight cortisol and have no appropriate diurnal rhythm and none of my ACTH during the 32 hour draws were below 13. Am pretty darn sure that I have Cushings and am in the false negative category for this test.

Thanks for giving me another chance to post my results there, Shelley.

Now if I could only figure out how to post my MRI pic of what I think is a tumor in the pituitary area. I think it is compressing the pit, but am certainly NO radiologist.

 

hugs,

Patti

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I failed that test. I have pathology that proves Cushings... I wonder if I should mail it in?

*sigh*

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As Jen, I also have BLA pathology that indeed proves Cushings beyond any doubt. Normal adrenals weight 4 to 6 grams. Mine were 19.5 and 26.0 totaling 45.5 grams which is a far cry from 4 grams.

 

I had the Dex/CRH test and I suppressed and I was not considered pseudo nor mild. I would be wary of anyone saying there was 'one' test to distinguish Cushings. Pehaps the authors should come talk to us!

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Hi, Shelley.

 

I had the dex/crh test as well....and my results were considered "very abnormal", however not diagnostic, since the upward spike in cortisol didn't happen until after 30 minutes. I believe the "diagnostic" level for the test is 1.4 or higher at the 15 minute mark.

 

My results were:

 

at 15 minutes: 1

at 30 minutes: 1

at 45 minutes: 2

at 60 minutes: 4

 

Earlier that same week, I had two high midnight serum tests (two nights in a row), one elevated ACTH at midnight, one high salivary, and two absolutely normal 24 hour ufcs done on the same days as the late night blood draws.

 

My surgical pathology confirmed Cushings.

 

Linda

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one elevated ACTH at midnight

 

 

Linda, what is the range for ACTH at midnight? I cannot find that anywhere I have researched. I attempted to use the ratios that I found at one of the published papers also to see if I could figure out what that number MIGHT be, but still have no clue if that is right or not.

 

That one paper said that ACTH above 10 at 4pm would be considered adrenal dependent cushings, but that is 8 hours before.

 

Could you post those ranges, please?

 

Hugs,

Patti

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Midnight ACTH of 23 or above is considered diagnostic. (NIH). Hope that helps.

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Thanks you guys---I thought this was something "old" 'cause the reference date was like 1998---but they had this on their website like it was something "new"---and hope springs eternal. I also included it because it referenced pseudo-cushings---something that either does or does not exist---depending on the doc.

 

This must have been the test that I "failed" at OHSU---my testing buddy got all "flushed" and was ready to jump out of her skin...now I find out that being on a sub par dose of thyroid at the time may have skewed my tests...

sigh...

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adrenal dependent cushings,

 

duh... I meant ACTH dependent cushings

 

I hate this brain fog thing

 

 

Thanks for that number there, Susan, guess I needed to search further.

 

Patti

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I don't know how "news-ish" this really is, but was surfing around and saw it:

 

A new test reliably distinguishes between patients with mild Cushing's syndrome, pseudo-Cushing's states, and normal individuals. Yanovski and others from the National Institutes of Health [J Clin Endocrinol Metab 83:348-352,1998] have reported results of studies employing the dexamethasone-suppressed corticotropin-releasing hormone stimulation test in normal volunteers and patients with mild Cushing's disease. A cortisol level obtained 15 minutes after the administration of corticotropin-releasing hormone was more accurate in the diagnosis of Cushing's disease than basal urine studies and dexamethasone- suppressed urine cortisol levels. This test seems useful in the evaluation of patients with suspected Cushing's syndrome that have normal or minimally elevated urinary steroid levels.

http://www.pituitarycenter.com/site/whatsnew.php#cush

 

Input from those of you who are "up to date" on the efficacy of tests is greatly appreciated.

 

This was the results of a study done by NIH (Not Vanderbilt) The report of the study is posted on the Vanderbilt pituitary center website. The results of the test showed that..... A cortisol level obtained 15 minutes after the administration of corticotropin-releasing hormone was more accurate in the diagnosis of Cushing's disease than basal urine studies and dexamethasone- suppressed urine cortisol levels. This test seems useful in the evaluation of patients with suspected Cushing's syndrome that have normal or minimally elevated urinary steroid levels.

 

I don't think this particular study was intended to prove that if someone failed the test necessarily meant they didn't have Cushing's. I think it was merely the results of a study done on normal volunteers and patients with mild Cushing's disease.

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ChattiCat,

Form what I was told this test was a" very promising test to distinguish cushings from psuedo cushings" when it was first introduced. Now, from what I have been told ( by the endo I had been seeing) "it isn't as promising as once thought." It is missing many people who have cushings. It can speed things up if you pass that test but it doesn't mean that a person doesn't have cushings if they fail that test. It doesn't even mean they are mild cushings. I can think of one lady who passed that test twice and failed it twice. The tests for cushings need to be improved.

Kate G

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Thanks you guys---I thought this was something "old" 'cause the reference date was like 1998---but they had this on their website like it was something "new"---and hope springs eternal. I also included it because it referenced pseudo-cushings---something that either does or does not exist---depending on the doc.

 

This must have been the test that I "failed" at OHSU---my testing buddy got all "flushed" and was ready to jump out of her skin...now I find out that being on a sub par dose of thyroid at the time may have skewed my tests...

sigh...

You mentioned being on a "sub par dose of thyroid" may have skewed your tests. Can you explain a little further on this? What thyroid med are you talking about; synthroid or cytomel?and what dose? Do all thyroid medications mess up the tests results? Also, do you know if any other medications effect test results? I think from researching on the web that anticonvulsunts and dopamine agonists [given for restless leg syndrome] will give a false negitive, but I'm not 100% positive if I'm correct on that point. Have you heard anything? about this?

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