Consensus on biomarker utility for ACTH-dependent Cushing’s syndrome: a pituitary society modified Delphi panel

Context

Biochemical test results are central to clinical decision-making for the diagnosis and management of Cushing’s syndrome (CS). With emerging research and increasing availability of different tests, updated consensus on the utility of these biomarkers is warranted.

Objective

To establish an updated consensus on the role of biomarkers in the diagnosis and monitoring of adrenocorticotropic hormone-dependent CS, address novel therapeutic approaches, and identify areas for future research.

Design

A modified two-round Delphi panel was conducted. Consensus was defined as ≥70% agreement/disagreement for Likert-scale statements or ≥70% selection of the same option for single-choice questions.

Setting

Participants represented a range of international expertise.

Participants

Forty-one participants took part in the Delphi panel, with no attrition between rounds (one non-clinician was not required to complete the second round). An eight-member Steering Committee guided statement development.

Results

Of statements designed to reach consensus, 45% (14/31) and 44% (11/25) statements reached consensus in Rounds 1 and 2, respectively. Notably, most panelists reported the use of late-night salivary cortisol for diagnosis of mild CS and for monitoring following pituitary surgery or medical or radiation therapy. Most panelists responded that block-and-replace therapies can be considered in patients with cyclical or severe CS, and consensus was reached that restoration of circadian rhythm is a treatment goal for patients with CS.

Conclusions

Areas of alignment among experts on the diagnosis and monitoring of CS are presented. The findings from this study are intended to support clinicians in their clinical decision-making and highlight priority areas for future research.