{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T18:16:45Z","timestamp":1790360205581,"version":"4.1.0"},"reference-count":31,"publisher":"The Endocrine Society","issue":"2","license":[{"start":{"date-parts":[[2024,7,26]],"date-time":"2024-07-26T00:00:00Z","timestamp":1721952000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,1,21]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Context<\/jats:title>\n                  <jats:p>The clinical presentation of Cushing syndrome (CS) overlaps with common conditions. Recommended screening tests are serum cortisol after 1-mg overnight dexamethasone suppression test (DST), urinary free cortisol (UFC), and late-night salivary cortisol (LNSC).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>We analyzed the diagnostic accuracy of screening tests in 615 patients without CS (263 suspected CS, 319 adrenal and 33 pituitary incidentaloma) and 40 with CS.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Principal component analysis, K-means clustering, and neural network were used to compute an integrated analysis among tests, comorbidities, and signs\/symptoms of hypercortisolism.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The diagnostic accuracy of screening tests for CS was high; DST and UFC were slightly superior to LNSC. The threshold of DST should be adapted to the population considered, especially in adrenal incidentaloma (AI) with mild autonomous cortisol secretion: The cutoff to differentiate CS should be increased to 196 nmol\/L. Diabetes, hypertension, and obesity were more common in patients without CS: The direction of their vectors was not aligned and their correlation with screening tests was poor. Clustering allowed us to differentiate those patients without CS into cluster 1 (aged osteoporotic patients with impaired screening tests), cluster 2 (hypertensive and metabolic phenotype), and cluster 3 (young individuals with a low likelihood of overt CS). A neural network model that combined screening tests and clinical presentation was able to predict the CS diagnosis in the validation cohort with 99% precision and 86% accuracy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Despite the high diagnostic accuracy of screening tests to detect CS, cortisol-related comorbidities or AI should be considered when interpreting a positive test.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1210\/clinem\/dgae517","type":"journal-article","created":{"date-parts":[[2024,7,26]],"date-time":"2024-07-26T09:28:44Z","timestamp":1721986124000},"page":"396-405","source":"Crossref","is-referenced-by-count":9,"title":["Clinical and Biochemical Data for the Diagnosis of Endogenous Hypercortisolism: The \u201cCushingomic\u201d Approach"],"prefix":"10.1210","volume":"110","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1456-8716","authenticated-orcid":false,"given":"Filippo","family":"Ceccato","sequence":"first","affiliation":[{"name":"Department of Medicine DIMED, University of Padova , 35128 Padua ,","place":["Italy"]},{"name":"Endocrine Disease Unit, University Hospital of Padova , 35128 Padua ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2196-1268","authenticated-orcid":false,"given":"Alessandro","family":"Bavaresco","sequence":"additional","affiliation":[{"name":"Department of Medicine DIMED, University of Padova , 35128 Padua ,","place":["Italy"]},{"name":"Endocrine Disease Unit, University Hospital of Padova , 35128 Padua ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0390-6823","authenticated-orcid":false,"given":"Eugenio","family":"Ragazzi","sequence":"additional","affiliation":[{"name":"Studium Patavinum, University of Padova , 35128 Padua ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1081-5727","authenticated-orcid":false,"given":"Mattia","family":"Barbot","sequence":"additional","affiliation":[{"name":"Department of Medicine DIMED, University of Padova , 35128 Padua ,","place":["Italy"]},{"name":"Endocrine Disease Unit, University Hospital of Padova , 35128 Padua ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2596-1652","authenticated-orcid":false,"given":"Marco","family":"Boscaro","sequence":"additional","affiliation":[{"name":"Department of Medicine DIMED, University of Padova , 35128 Padua ,","place":["Italy"]},{"name":"Endocrine Disease Unit, University Hospital of Padova , 35128 Padua ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8745-6171","authenticated-orcid":false,"given":"Daniela","family":"Basso","sequence":"additional","affiliation":[{"name":"Department of Medicine DIMED, University of Padova , 35128 Padua ,","place":["Italy"]},{"name":"Laboratory Medicine Unit, University Hospital of Padova , 35128 Padua ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9396-3815","authenticated-orcid":false,"given":"Carla","family":"Scaroni","sequence":"additional","affiliation":[{"name":"Department of Medicine DIMED, University of Padova , 35128 Padua ,","place":["Italy"]},{"name":"Endocrine Disease Unit, University Hospital of Padova , 35128 Padua ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3622-5378","authenticated-orcid":false,"given":"Giorgia","family":"Antonelli","sequence":"additional","affiliation":[{"name":"Department of Medicine DIMED, University of Padova , 35128 Padua ,","place":["Italy"]},{"name":"Laboratory Medicine Unit, University Hospital of Padova , 35128 Padua ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2024,7,26]]},"reference":[{"issue":"9","key":"2025012110280771900_dgae517-B1","doi-asserted-by":"crossref","first-page":"3121","DOI":"10.1210\/jc.2009-0612","article-title":"Approach to the patient with possible Cushing's syndrome","volume":"94","author":"Boscaro","year":"2009","journal-title":"J Clin Endocrinol Metab"},{"issue":"12","key":"2025012110280771900_dgae517-B2","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1016\/S2213-8587(21)00235-7","article-title":"Consensus on diagnosis and management of Cushing's disease: a guideline update","volume":"9","author":"Fleseriu","year":"2021","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"3","key":"2025012110280771900_dgae517-B3","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1007\/s11102-014-0569-6","article-title":"Incidence of Cushing's syndrome and Cushing's disease in commercially-insured patients &lt; 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