{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T00:49:58Z","timestamp":1790470198968,"version":"4.1.0"},"reference-count":30,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Horm Metab Res"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The purpose of this study was to determine possible cut-off levels of basal\n                    DHEA-S percentile rank in the differential diagnosis of patients with\n                    Cushing\u2019s syndrome (CS) with ACTH levels in the gray zone and normal\n                    DHEA-S levels.<\/jats:p><jats:p> In this retrospective study including 623 pathologically confirmed CS, the\n                    DHEA-S percentile rank was calculated in 389 patients with DHEA-S levels within\n                    reference interval. The patients were classified as group 1 (n=265\n                    Cushing\u2019s disease; CD), group 2 (n=104 adrenal CS) and group 3\n                    (n=20 ectopic ACTH syndrome).ROC-curve analyses were used to calculate\n                    the optimal cut-off level of DHEA-S percentile rank in the reference interval in\n                    the differential diagnosis of CS, and the effectiveness of this cut-off level in\n                    the identification of the accurate etiology of CS was assessed in patients who\n                    were in gray zone according to their ACTH levels.<\/jats:p><jats:p> The DHEA-S percentile rank in the reference interval were significantly\n                    lower in group 2 compared to the other two groups (p&lt;0.001), while group\n                    1 and group 3 had similar levels. The optimal cut-off level of DHEA-S percentile\n                    rank in the reference interval providing differential diagnosis between group 1\n                    and group 2 was calculated as 19.5th percentile (80.8% sensitivity,\n                    81.5% specificity) and the level demonstrated the accurate etiology in\n                    100% of CD and 76% of adrenal CS patients who were in the gray\n                    zone.<\/jats:p><jats:p> This study showed that the cut-off value of DHEA-S level less than\n                    20% of the reference interval could be used for differential diagnosis\n                    of CD and adrenal CS with high sensitivity and specificity, and it should be\n                    taken into the initial evaluation.<\/jats:p>","DOI":"10.1055\/a-1783-7901","type":"journal-article","created":{"date-parts":[[2022,4,12]],"date-time":"2022-04-12T22:48:01Z","timestamp":1649803681000},"page":"232-237","source":"Crossref","is-referenced-by-count":12,"title":["The Importance of DHEA-S Levels in Cushing\u2019s Syndrome; Is\n                    There a Cut-off Value in the Differential Diagnosis?"],"prefix":"10.1055","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0383-6562","authenticated-orcid":false,"given":"Sema","family":"Ciftci","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolsim, University of Health\n                    Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul,\n                    Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ozlem","family":"Soyluk","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Istanbul University, Fatih,\n                    Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alev","family":"Selek","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Kocaeli University,\n                    Kocaeli, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Selvinaz","family":"Erol","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, University of Health\n                    Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul,\n                    Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeliha","family":"Hekimsoy","sequence":"additional","affiliation":[{"name":"Endocrinology, Celal Bayar University, Manisa, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayse","family":"Esen","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolsim, University of Health\n                    Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul,\n                    Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huseyin","family":"Dursun","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Meatbolism, Erciyes University School\n                    of Medicine, Kayseri, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serdar","family":"Sahin","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Istanbul University\n                    Cerrahpasa Faculty of Medicine, Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gonca","family":"Oruk","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Izmir Ataturk Training and\n                    Research Hospital, Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meral","family":"Mert","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolsim, University of Health\n                    Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul,\n                    Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huseyin","family":"Soylu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Ondokuz Mayis University,\n                    School of Medicine, Samsun, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Banu Sarer","family":"Yurekli","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Ege University Faculty of\n                    Medicine, Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melek Eda","family":"Ertorer","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Baskent University Faculty\n                    of Medicine, Adana, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tulay","family":"Omma","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Ankara Training and\n                    Research Hospital, Ankara, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehtap","family":"Evran","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, \u00c7ukurova University\n                    Medical Faculty, Adana, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mine","family":"Adas","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, University of Health\n                    Sciences, Okmeydani Training and Research Hospital, Istanbul,\n                    Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9220-6118","authenticated-orcid":false,"given":"Seher","family":"Tanrikulu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolsim, Haydarpa\u015fa Numune\n                    Training and Research Hospital, Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kadriye","family":"Aydin","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Kartal Dr. Lutfi Kirdar\n                    Training and Research Hospital, Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zafer","family":"Pekkolay","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Dicle Faculty of Medicine,\n                    Diyarbak\u0131r, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6382-1306","authenticated-orcid":false,"given":"B\u00fclent","family":"Can","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Istanbul Medeniyet\n                    University Faculty of Medicine, \u0130stanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ersen","family":"Karakilic","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Canakkale Onsekiz Mart\n                    University Medical Faculty, \u00c7anakkale, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zuleyha","family":"Karaca","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Meatbolism, Erciyes University School\n                    of Medicine, Kayseri, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Habib","family":"Bilen","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Ataturk University Faculty\n                    of Medicine, Ezurum, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeynep","family":"Canturk","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Kocaeli University,\n                    Kocaeli, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berrin","family":"Cetinarslan","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Kocaeli University,\n                    Kocaeli, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pinar","family":"Kadioglu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Istanbul University\n                    Cerrahpasa Faculty of Medicine, Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sema","family":"Yarman","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Istanbul University, Fatih,\n                    Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2022,4,12]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1056\/NEJM199503233321207","article-title":"Cushing\u2019s syndrome","volume":"332","author":"D N Orth","year":"1995","journal-title":"N Engl J Med"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"1526","DOI":"10.1210\/jc.2008-0125","article-title":"The diagnosis of Cushing\u2019s syndrome: an endocrine society clinical\n                    practice guideline","volume":"93","author":"L K Nieman","year":"2008","journal-title":"J Clin Endocrinol 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Adrenal Androgens","author":"M J O\u2019Hare","year":"1980"},{"key":"ref29","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1016\/j.jfma.2016.08.008","article-title":"Adrenocorticotropic hormone levels before treatment predict recurrence of\n                    Cushing\u2019s disease","volume":"116","author":"C H Kuo","year":"2017","journal-title":"J Formos Med Assoc"},{"key":"ref30","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1210\/jc.2017-01797","article-title":"The value of perioperative levels of ACTH, DHEA, and DHEA-S and tumor size in\n                    predicting recurrence of Cushing disease","volume":"103","author":"N El Asmar","year":"2018","journal-title":"J Clin Endocrinol Metab"}],"container-title":["Hormone and Metabolic Research"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-1783-7901.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,4,12]],"date-time":"2022-04-12T22:50:25Z","timestamp":1649803825000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-1783-7901"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4]]},"references-count":30,"journal-issue":{"issue":"04","published-online":{"date-parts":[[2022,4,12]]},"published-print":{"date-parts":[[2022,4]]}},"URL":"https:\/\/doi.org\/10.1055\/a-1783-7901","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0018-5043","1439-4286"],"issn-type":[{"value":"0018-5043","type":"print"},{"value":"1439-4286","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4]]}}}