{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T23:11:02Z","timestamp":1777504262475,"version":"3.51.4"},"reference-count":43,"publisher":"Oxford University Press (OUP)","issue":"5","content-domain":{"domain":["eje.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2017,5]]},"abstract":"<jats:sec>\n<jats:title>Objective<\/jats:title>\n<jats:p>To evaluate which tests are performed to diagnose hypercortisolism in patients included in the European Registry on Cushing\u2019s syndrome (ERCUSYN), and to examine if their use differs from the current guidelines.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Patients and methods<\/jats:title>\n<jats:p>We analyzed data on the diagnostic tests performed in 1341 patients with Cushing\u2019s syndrome (CS) who have been entered into the ERCUSYN database between January 1, 2000 and January 31, 2016 from 57 centers in 26 European countries. Sixty-seven percent had pituitary-dependent CS (PIT-CS), 24% had adrenal-dependent CS (ADR-CS), 6% had CS from an ectopic source (ECT-CS) and 3% were classified as having CS from other causes (OTH-CS).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Of the first-line tests, urinary free cortisol (UFC) test was performed in 78% of patients, overnight 1\u2009mg dexamethasone suppression test (DST) in 60% and late-night salivary cortisol (LSaC) in 25%. Use of LSaC increased in the last five years as compared with previous years (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01). Use of HDDST was slightly more frequent in the last 5 years as compared with previous years (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05). Of the additional tests, late-night serum cortisol (LSeC) was measured in 62% and 48-h 2\u2009mg\/day low-dose dexamethasone suppression test (LDDST) in 33% of cases. ACTH was performed in 78% of patients. LSeC and overnight 1\u2009mg DST supported the diagnosis of both PIT-CS and ADR-CS more frequently than UFC (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Use of diagnostic tests for CS varies across Europe and partly differs from the currently available guidelines. It would seem pertinent that a European consensus be established to determine the best diagnostic approach to CS, taking into account specific inter-country differences with regard to the availability of diagnostic tools.<\/jats:p>\n<\/jats:sec>","DOI":"10.1530\/eje-16-0967","type":"journal-article","created":{"date-parts":[[2017,4,5]],"date-time":"2017-04-05T00:15:51Z","timestamp":1491351351000},"page":"613-624","update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-1","source":"Crossref","is-referenced-by-count":48,"title":["Diagnostic tests for Cushing's syndrome differ from published guidelines: data from ERCUSYN"],"prefix":"10.1093","volume":"176","author":[{"given":"Elena","family":"Valassi","sequence":"first","affiliation":[{"name":"1IIB-Sant Pau and Department of Endocrinology\/MedicineHospital Sant Pau, UAB, and Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, Barcelona, Spain"}]},{"given":"Holger","family":"Franz","sequence":"additional","affiliation":[{"name":"2Lohmann & Birkner Health Care Consulting GmbHBerlin, Germany"}]},{"given":"Thierry","family":"Brue","sequence":"additional","affiliation":[{"name":"3Aix-Marseille Universit\u00e9CNRS, CRN2M UMR 7286, and APHM, H\u00f4pital Conception, Marseille, France"}]},{"given":"Richard A","family":"Feelders","sequence":"additional","affiliation":[{"name":"4Erasmus University Medical CentreRotterdam, The Netherlands"}]},{"given":"Romana","family":"Netea-Maier","sequence":"additional","affiliation":[{"name":"5Radboud University Medical CentreNijmegen, The Netherlands"}]},{"given":"Stylianos","family":"Tsagarakis","sequence":"additional","affiliation":[{"name":"6Athens Polyclinic General HospitalEvangelismos Hospital, Athens, Greece"}]},{"given":"Susan M","family":"Webb","sequence":"additional","affiliation":[{"name":"1IIB-Sant Pau and Department of Endocrinology\/MedicineHospital Sant Pau, UAB, and Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, Barcelona, Spain"}]},{"given":"Maria","family":"Yaneva","sequence":"additional","affiliation":[{"name":"7Medical University of SofiaSofia, Bulgary"}]},{"given":"Martin","family":"Reincke","sequence":"additional","affiliation":[{"name":"8Medizinische Klinik und Poliklinik IVCampus Innestadt, Klinikum der Universit\u00e4t M\u00fcnchen, M\u00fcnchen, Germany"}]},{"given":"Michael","family":"Droste","sequence":"additional","affiliation":[{"name":"9Praxis f\u00fcr Endokrinologie DrosteOldenburg, Germany"}]},{"given":"Irina","family":"Komerdus","sequence":"additional","affiliation":[{"name":"10Moscow Regional Research Clinical InstituteMoscow, Russia"}]},{"given":"Dominique","family":"Maiter","sequence":"additional","affiliation":[{"name":"11UCL Cliniques Universitaires St LucBrussels, Belgium"}]},{"given":"Darko","family":"Kastelan","sequence":"additional","affiliation":[{"name":"12Department of EndocrinologyUniversity Hospital Zagreb, School of Medicine University of Zagreb, Zagreb, Croatia"}]},{"given":"Philippe","family":"Chanson","sequence":"additional","affiliation":[{"name":"13Univ Paris-SudUniversit\u00e9 Paris-Saclay UMR-S1185, Le Kremlin Bic\u00eatre, Paris, France"},{"name":"14Assistance Publique-H\u00f4pitaux de ParisH\u00f4pital de Bic\u00eatre, Service de Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bic\u00eatre, Paris, France"},{"name":"15Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale U1185Le Kremlin Bic\u00eatre, Paris, France"}]},{"given":"Marija","family":"Pfeifer","sequence":"additional","affiliation":[{"name":"16Department of EndocrinologyUniversity Medical Centre Ljubljana, Ljubljana, Slovenia"}]},{"given":"Christian J","family":"Strasburger","sequence":"additional","affiliation":[{"name":"17Division of Clinical EndocrinologyDepartment of Medicine CCM, Charit\u00e9-Universit\u00e4tsmedizin, Berlin, Germany"}]},{"given":"Mikl\u00f3s","family":"T\u00f3th","sequence":"additional","affiliation":[{"name":"182nd Department of MedicineSemmelweis University, Budapest, Hungary"}]},{"given":"Olivier","family":"Chabre","sequence":"additional","affiliation":[{"name":"19Service d\u2019Endocrinologie-Diab\u00e9tologie-NutritionGrenoble Cedex, France"}]},{"given":"Antoine","family":"Tabarin","sequence":"additional","affiliation":[{"name":"20Centre Hospitalier Universitaire de BordeauxBordeaux, France"}]},{"given":"Michal","family":"Krsek","sequence":"additional","affiliation":[{"name":"212nd Department of Internal Medicine3rd Faculty of Medicine and University Hospital Kralovske Vinohrady, Prague, Czech Republic"}]},{"given":"Carmen","family":"Fajardo","sequence":"additional","affiliation":[{"name":"22Department of EndocrinologyHospital Universitario de la Ribera, Alzira, Spain"}]},{"given":"Marek","family":"Bolanowski","sequence":"additional","affiliation":[{"name":"23Department of 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