The Cushing Syndrome

Peter C. Avgerinos; Gordon B. Cutler Jr.

doi:10.7326/0003-4819-122-12-199506150-00013

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TO THE EDITOR:

In his editorial, Orth [1] raises several concerns about our paper [2]. He criticizes our use of cut-off criteria that maintain 100% test specificity. From a clinical standpoint, the rationale for achieving a specificity of nearly 100% is to avoid misclassifying cases of ectopic adrenocorticortropic hormone (ACTH) syndrome as Cushing disease, an error that would lead to inappropriate pituitary surgery.

Second, Dr. Orth suggests that restricting the study to patients whose 24-hour urine collections varied no more than 10% might have yielded different cut-off criteria and different study results. We have reanalyzed the study using coefficients of variation of 10% or less (Table 1). Diagnosis was based on information obtained at trans-sphenoidal surgery or during follow-up. The reanalysis yielded identical cut-off criteria. Thus, restricting the analysis to patients with less variation in creatinine exertion did not appreciably alter the results.

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Letters |15 June 1995

The Cushing Syndrome

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Letters |15 June 1995

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