How useful is 24 hour Urinary Free Cortisol as a screening tool for Cushing’s syndrome?

Ahmed Hanafy, Chinnadorai Rajeswaran, Saad Saddiq, Warren Gillibrand, John Stephenson

Research output: Contribution to journalMeeting Abstract

Abstract

Introduction
Cushing’s syndrome (CS) is a rare disease that can be difficult to diagnose.
24 hour urinary free cortisol (UFC) is one of the reliable screening tests to
diagnose CS. The Endocrine Society recommends against widespread screening
for CS. It advises to screen those patients presenting with multiple and
progressive features (easy bruising, facial plethora, proximal myopathy and
striae) of CS, in addition to patients who experience unusual features for their age
(osteoporosis, hypertension).
Methods
A retrospective audit was done to assess our practice of requesting 24 hour UFC in
patients attending Diabetes, Endocrine and Weight management clinics in MidYorkshire
Hospital over 3 years. 356 patients were eligible for final analysis.
Results
66.6% of the patients were females and 33.4% were men. The mean age in our
cohort was 44.9 years and the mean BMI was 35.8 Kg/m2
. 61% of the patients had
hypertension and 21.6% had diabetes. The reason for requesting 24 h UFC is as
follows: 41% for secondary hypertension, 21% for obesity, 14% for adrenal
incidentaloma, 5% for clinical suspicion of Cushing’s, 19% for other reasons
(hirsutism, uncontrolled diabetes, flushing). Thirty one patients (8.7%) had
clinical features of Cushing’s syndrome. Among those with Cushingoid features,
seven patients (22.5%) had raised 24 hour UFC and four patients (12.9%) were
finally diagnosed with CS. 325 patients had 24 h UFC test requested despite
lacking clinical features of Cushing’s. Twenty nine patients (8.9%) had initial
positive 24 h UFC. Only two patients (0.6%) were finally diagnosed with CS.
These two patients had the test because of adrenal incidentaloma.
Conclusion
We did not find any benefit of requesting 24 h UFC in those who did not have
classic Cushingoid features. This audit confirms that it we need to adhere to the
Endocrine society guidelines on investigations for CS.
Original languageEnglish
Pages (from-to)PO28
Number of pages1
JournalEndocrine Abstracts
Volume59
DOIs
Publication statusPublished - 19 Nov 2018
EventAnnual BES Conference of the Society for Endocrinology - Scottish Event Campus, Glasgow, United Kingdom
Duration: 19 Nov 201821 Nov 2018
https://www.endocrinology.org/events/sfe-bes-conference/sfe-bes-2018/ (Link to Conference Information)

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Cushing Syndrome
Hydrocortisone
Hypertension
Hirsutism
Muscular Diseases
Rare Diseases
Osteoporosis
Inpatients
Obesity
Guidelines

Cite this

@article{fc05ecc21d7d400992fc00e816889a00,
title = "How useful is 24 hour Urinary Free Cortisol as a screening tool for Cushing’s syndrome?",
abstract = "IntroductionCushing’s syndrome (CS) is a rare disease that can be difficult to diagnose.24 hour urinary free cortisol (UFC) is one of the reliable screening tests todiagnose CS. The Endocrine Society recommends against widespread screeningfor CS. It advises to screen those patients presenting with multiple andprogressive features (easy bruising, facial plethora, proximal myopathy andstriae) of CS, in addition to patients who experience unusual features for their age(osteoporosis, hypertension).MethodsA retrospective audit was done to assess our practice of requesting 24 hour UFC inpatients attending Diabetes, Endocrine and Weight management clinics in MidYorkshireHospital over 3 years. 356 patients were eligible for final analysis.Results66.6{\%} of the patients were females and 33.4{\%} were men. The mean age in ourcohort was 44.9 years and the mean BMI was 35.8 Kg/m2. 61{\%} of the patients hadhypertension and 21.6{\%} had diabetes. The reason for requesting 24 h UFC is asfollows: 41{\%} for secondary hypertension, 21{\%} for obesity, 14{\%} for adrenalincidentaloma, 5{\%} for clinical suspicion of Cushing’s, 19{\%} for other reasons(hirsutism, uncontrolled diabetes, flushing). Thirty one patients (8.7{\%}) hadclinical features of Cushing’s syndrome. Among those with Cushingoid features,seven patients (22.5{\%}) had raised 24 hour UFC and four patients (12.9{\%}) werefinally diagnosed with CS. 325 patients had 24 h UFC test requested despitelacking clinical features of Cushing’s. Twenty nine patients (8.9{\%}) had initialpositive 24 h UFC. Only two patients (0.6{\%}) were finally diagnosed with CS.These two patients had the test because of adrenal incidentaloma.ConclusionWe did not find any benefit of requesting 24 h UFC in those who did not haveclassic Cushingoid features. This audit confirms that it we need to adhere to theEndocrine society guidelines on investigations for CS.",
author = "Ahmed Hanafy and Chinnadorai Rajeswaran and Saad Saddiq and Warren Gillibrand and John Stephenson",
year = "2018",
month = "11",
day = "19",
doi = "10.1530/endoabs.59.P028",
language = "English",
volume = "59",
pages = "PO28",
journal = "Endocrine Abstracts",
issn = "1470-3947",

}

How useful is 24 hour Urinary Free Cortisol as a screening tool for Cushing’s syndrome? / Hanafy, Ahmed ; Rajeswaran, Chinnadorai ; Saddiq, Saad; Gillibrand, Warren; Stephenson, John.

In: Endocrine Abstracts, Vol. 59, 19.11.2018, p. PO28.

Research output: Contribution to journalMeeting Abstract

TY - JOUR

T1 - How useful is 24 hour Urinary Free Cortisol as a screening tool for Cushing’s syndrome?

AU - Hanafy, Ahmed

AU - Rajeswaran, Chinnadorai

AU - Saddiq, Saad

AU - Gillibrand, Warren

AU - Stephenson, John

PY - 2018/11/19

Y1 - 2018/11/19

N2 - IntroductionCushing’s syndrome (CS) is a rare disease that can be difficult to diagnose.24 hour urinary free cortisol (UFC) is one of the reliable screening tests todiagnose CS. The Endocrine Society recommends against widespread screeningfor CS. It advises to screen those patients presenting with multiple andprogressive features (easy bruising, facial plethora, proximal myopathy andstriae) of CS, in addition to patients who experience unusual features for their age(osteoporosis, hypertension).MethodsA retrospective audit was done to assess our practice of requesting 24 hour UFC inpatients attending Diabetes, Endocrine and Weight management clinics in MidYorkshireHospital over 3 years. 356 patients were eligible for final analysis.Results66.6% of the patients were females and 33.4% were men. The mean age in ourcohort was 44.9 years and the mean BMI was 35.8 Kg/m2. 61% of the patients hadhypertension and 21.6% had diabetes. The reason for requesting 24 h UFC is asfollows: 41% for secondary hypertension, 21% for obesity, 14% for adrenalincidentaloma, 5% for clinical suspicion of Cushing’s, 19% for other reasons(hirsutism, uncontrolled diabetes, flushing). Thirty one patients (8.7%) hadclinical features of Cushing’s syndrome. Among those with Cushingoid features,seven patients (22.5%) had raised 24 hour UFC and four patients (12.9%) werefinally diagnosed with CS. 325 patients had 24 h UFC test requested despitelacking clinical features of Cushing’s. Twenty nine patients (8.9%) had initialpositive 24 h UFC. Only two patients (0.6%) were finally diagnosed with CS.These two patients had the test because of adrenal incidentaloma.ConclusionWe did not find any benefit of requesting 24 h UFC in those who did not haveclassic Cushingoid features. This audit confirms that it we need to adhere to theEndocrine society guidelines on investigations for CS.

AB - IntroductionCushing’s syndrome (CS) is a rare disease that can be difficult to diagnose.24 hour urinary free cortisol (UFC) is one of the reliable screening tests todiagnose CS. The Endocrine Society recommends against widespread screeningfor CS. It advises to screen those patients presenting with multiple andprogressive features (easy bruising, facial plethora, proximal myopathy andstriae) of CS, in addition to patients who experience unusual features for their age(osteoporosis, hypertension).MethodsA retrospective audit was done to assess our practice of requesting 24 hour UFC inpatients attending Diabetes, Endocrine and Weight management clinics in MidYorkshireHospital over 3 years. 356 patients were eligible for final analysis.Results66.6% of the patients were females and 33.4% were men. The mean age in ourcohort was 44.9 years and the mean BMI was 35.8 Kg/m2. 61% of the patients hadhypertension and 21.6% had diabetes. The reason for requesting 24 h UFC is asfollows: 41% for secondary hypertension, 21% for obesity, 14% for adrenalincidentaloma, 5% for clinical suspicion of Cushing’s, 19% for other reasons(hirsutism, uncontrolled diabetes, flushing). Thirty one patients (8.7%) hadclinical features of Cushing’s syndrome. Among those with Cushingoid features,seven patients (22.5%) had raised 24 hour UFC and four patients (12.9%) werefinally diagnosed with CS. 325 patients had 24 h UFC test requested despitelacking clinical features of Cushing’s. Twenty nine patients (8.9%) had initialpositive 24 h UFC. Only two patients (0.6%) were finally diagnosed with CS.These two patients had the test because of adrenal incidentaloma.ConclusionWe did not find any benefit of requesting 24 h UFC in those who did not haveclassic Cushingoid features. This audit confirms that it we need to adhere to theEndocrine society guidelines on investigations for CS.

U2 - 10.1530/endoabs.59.P028

DO - 10.1530/endoabs.59.P028

M3 - Meeting Abstract

VL - 59

SP - PO28

JO - Endocrine Abstracts

JF - Endocrine Abstracts

SN - 1470-3947

ER -