Current views of the screening and diagnostics of endogenous hypercorticism
The present review is concerned with the up-to-date methods currently available for diagnostics of endogenous hypercorticism. The clinical picture of this condition is considered in conjunction with the epidemiological data, identification of risk groups and the choice of the patients for the screening studies. The main attention is given to the diagnostic modalities of the highest informative value, technically simple and providing readily interpretable results, viz. measurement of cortisol in daily urine, minor dexamethasone test, determination of cortisol in evening saliva). The estimation of sensitivity of these techniques, their specificity, and cut-off values is discussed. The procedures and limitations of each test are described in much detail. In addition, an algorithm for the performance of two or more tests is proposed allowing to lower the maximum sensitivity and specificity levels of the determination. The methods of screening are presented in such a way as to facilitate their practical application by the general practitioners and specialists in related disciplines for the establishment of diagnosis of endogenous hypercorticism (but not elucidation of its origin).