7399 Validation of Cushing’s Diagnostic Scoring Systems in a Multicenter US Based Population

Abstract Disclosure: S. Mehta: None. K.L. Havranek: None. D. Pacione: None. K. Yuen: Advisory Board Member; Self; Corcept, Recordati, Xeris. Consulting Fee; Self; Novo Nordisk, Ipsen, Amryt Pharma, Crinetics Pharmaceuticals, Recordati, Xeris Biopharma. Grant Recipient; Self; Barrow Neurological Institute, Corcept Therapeutics, Sparrow Pharmaceuticals. Speaker; Self; Recordati, Corcept. L. Zhang: None. A. Little: Consulting Fee; Self; SPIWAY and BK Medical Systems. Stock Owner; Self; Kogent Surgical. M. Karsy: None. J.J. Evans: None. W. Kim: Consulting Fee; Self; Monteris Medical. C. Benjamin: None. P.A. Gardner: Consulting Fee; Self; SPIWAY, Lazic Instruments. J.C. Fernandez-Miranda: Consulting Fee; Self; Medtronic Minimed, Stryker, Hotry. G. Zada: None. R. Rennert: None. J.M. Silverstein: Research Investigator; Self; Ascendis Pharma, Bayer, Inc., Camurus, Sparrow. V. Kshettry: Consulting Fee; Self; Stryker, Integra. M. Chicoine: None. R. Shih: None. J. Salcedo: None. N. Agrawal: Research Investigator; Self; Ascendis Pharma, Recordati, Amryt, Xeris. Cushing’s syndrome (CS) is difficult to diagnose, leading to a mean lag of 3-4 years which contributes to disease burden and comorbidities despite biochemical remission and cortisol normalization. It is therefore reasonable to explore a scoring system of clinical manifestations to improve diagnostic accuracy. Justel et al. (Spain) described a risk score to predict CS in an at-risk population using clinical signs and symptoms and Parasiliti-Caprino et al. (Italy) developed and validated another clinical model to estimate the pre-test probability of CS. Our study aims to validate the two existing CS clinical scoring systems in a large United States based population. This is a retrospective scoring analysis of patients with confirmed Cushing’s disease (CD) based on a large multicenter pituitary surgical database from the RAPID (Registry for Adenomas of the Pituitary and related Disorders) Consortium. We reviewed data on 160 patients (mean age 44 years, 80% female), with pathologically confirmed CD and calculated the probability of having CD using both scoring systems. In our cohort, using the Spanish scoring system, 59% of patients scored as “high” probability and 41% scored as “low” probability. This is much lower than previously reported sensitivity of 96%. Specificity could not be calculated given lack of controls. Logistic regression analysis found that dorsal cervical fat pad was the highest clinical predicto