{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T18:13:31Z","timestamp":1779905611843,"version":"3.53.1"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"2","content-domain":{"domain":["eje.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2015,8]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>The aim of the present study was to validate criteria of corticotropin-releasing hormone (CRH) stimulation and 8\u200amg dexamethasone suppression (high-dose dexamethasone suppression, HDDS) to distinguish the etiology of ACTH-dependent Cushing's syndrome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Subjects and methods<\/jats:title><jats:p>We retrospectively analyzed cortisol and ACTH after the injection of 100\u200a\u03bcg human CRH in confirmed Cushing's disease (CD, <jats:italic>n<\/jats:italic>=78) and confirmed ectopic Cushing's syndrome (ECS, <jats:italic>n<\/jats:italic>=18). Cortisol and ACTH increase (in percentage above basal (%<jats:sub>B<\/jats:sub>)) at each time point, maximal increase (\u0394max %<jats:sub>B<\/jats:sub>), and area under the curve (AUC %<jats:sub>B<\/jats:sub>) were analyzed using receiver operator characteristics (ROC) curve analyses. Cortisol suppression (%<jats:sub>B<\/jats:sub>) after 8\u200amg of dexamethasone was evaluated as a supplementary criterion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>An increase in ACTH of \u226543%<jats:sub>B<\/jats:sub> at 15\u200amin after CRH was the strongest predictor of CD, with a positive likelihood ratio of 14.0, a sensitivity of 83%, a specificity of 94%, a positive predictive value of 98% and a negative predictive value of 58%. All of the other criteria of stimulated ACTH and cortisol levels were not superior in predicting CD in response to CRH injection. The addition of cortisol suppression by dexamethasone did not increase the discriminatory power. However, the combination of a positive ACTH response at 15\u200amin and a positive HDDS test excluded ECS in all cases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The present findings support the use of plasma ACTH levels 15\u200amin after the injection of human CRH as a response criterion for distinguishing between CD and ECS. The addition of the HDDS test is helpful for excluding ECS when both tests are positive.<\/jats:p><\/jats:sec>","DOI":"10.1530\/eje-14-0912","type":"journal-article","created":{"date-parts":[[2015,5,8]],"date-time":"2015-05-08T02:41:57Z","timestamp":1431052917000},"page":"197-204","update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-1","source":"Crossref","is-referenced-by-count":37,"title":["ACTH after 15\u200amin distinguishes between Cushing's disease and ectopic Cushing's syndrome: a proposal for a short and simple CRH test"],"prefix":"10.1093","volume":"173","author":[{"given":"Katrin","family":"Ritzel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Beuschlein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Berr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Osswald","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Reisch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Bidlingmaier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harald","family":"Schneider","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fcrgen","family":"Honegger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas L.","family":"Geyer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jochen","family":"Schopohl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Reincke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","reference":[{"key":"2015070319494913000_173.2.197.1","doi-asserted-by":"publisher","DOI":"10.1210\/er.19.5.647"},{"key":"2015070319494913000_173.2.197.2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2003-032249"},{"key":"2015070319494913000_173.2.197.3","unstructured":"Schurmeyer TH Schulte HM Avgerinos PC Tomai TP Loriaux DL Gold PW Chrousos GP . 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