RELIABILITY OF THE CORTICOTROPIN RELEASING HORMONE STIMULATION TEST FOR DIFFERENTIATING BETWEEN ACTH DEPENDENT AND INDEPENDENT CUSHING SYNDROME.

CONTEXT: It is a challenge to determine the origin of Cushing syndrome (CS), especially in patients with low-normal adrenocorticotropic hormone (ACTH) concentrations. OBJECTIVE: To evaluate the reliability of the corticotropin-releasing hormone (CRH) stimulation test in patients with CS whose origin of disease was not clearly identified using ACTH values, the high-dose dexamethasone suppression test (HDDST), and imaging in a single tertiary referral center. DESIGN AND METHODS: Twenty-one patients with CS who were admitted to the endocrinology-metabolism clinic between 2004 and 2016 whose ACTH concentrations were 5-20 pg/mL and needed CRH stimulation test were retrospectively assessed. RESULTS: Nine out of 21 patients were diagnosed as having Cushing's disease (CD) and 12/21 had adrenal CS. The CRH stimulation test had a sensitivity and specificity of 100% and 8%, and positive and negative predictive values of 100% and 45% according to the current diagnostic criteria, respectively. An increase in ACTH ≥115% at 15 minutes and cortisol ≥86% at 60 minutes after CRH were associated with the highest likelihood ratio. The sensitivity and specificity of ACTH was 67% and 83% (AUC=0.75±0.12, 95% CI: [0.5-0.9]; p=0.03), and for cortisol it was 75% and 78% (AUC=0.71±0.15, 95% CI: [0.5-0.9]; p=0.03). Cortisol suppression of more than 64% from basal level in the HDDST suggested CD with the highest likelihood ratio. When these cut-off values were used together, both tests were negative in the patients with CD. CONCLUSION: The CRH stimulation test has low specificity to localize CS in patients with ACTH concentrations of 5-20 pg/mL according to the current diagnostic criteria. Different diagnostic criteria may be used in the CRH stimulation test and also in the HDDST in this group of patients.

Comparing SARC-F with SARC-CalF to Screen Sarcopenia in Community Living Older Adults.

OBJECTIVE: To compare the diagnostic value of the SARC-F combined with calf circumference (SARC-CalF) with the standard SARC-F to screen sarcopenia in community-dwelling older adults. DESIGN: Cross-sectional, diagnostic accuracy study. SETTING: Geriatric outpatient clinic of a university hospital. PARTICIPANTS: Older adults >= 65 years. MEASUREMENTS: Muscle mass (bioimpedance analysis device), muscle strength (hand grip strength-Jamar hydraulic hand dynamometer), and physical performance (usual gait speed). Four currently used diagnostic criteria [European Working Group on Sarcopenia in Older People (EWGSOP), Foundation for the National Institutes of Health (FNIH), International Working Group on Sarcopenia (IWGS), and Society on Sarcopenia Cachexia and Wasting Disorders (SCWD) criteria] were applied. SARC-CalF was performed by using two different calf circumference threshold: standard cut-off 31 cm (SARC-CalF-31) and national cut-off 33 cm (SARC-CalF-33). The sensitivity/specificity analyses of the SARC-CalF and SARC-F tools were run. We used the receiver operating characteristics curves and the area under the receiver operating characteristics curves (AUC) to compare the diagnostic accuracy to identify sarcopenia. RESULTS: We included 207 subjects; 67 male and 140 female with a mean age of 74.6±6.7 years. The prevalence of sarcopenia ranged from 1.9% to 9.2%. The sensitivity of SARC-F was between 25% (EWGSOP) and 50% (IWGS); specificity was about 82%. For SARC-CalF-31 and SARC-CalF-33 sensitivity was in general similar -between 25-50%- which pointed out that SARC-CalF was not superior to SARC-F for sensitivity in this sample. Corresponding specificities for SARC-CalF-31 and SARC-CalF-33 were higher than SARC-F and were between 90-98%. Additionally, the AUC values, which indicates the diagnostic accuracy of a screening test, were in general higher for SARC-CalF-33 than the SARC-F and SARC-CalF-31. CONCLUSIONS: We reported that addition of calf circumference item to SARC-F tool improved the specificity and diagnostic accuracy of SARC-F but it did not improve the sensitivity in a community-dwelling Turkish older adult population sample that had low prevalence of sarcopenia. The performance of SARC-CalF tool to screen sarcopenia is to be studied in different populations and living settings.

Reliability and validity of Turkish version of the Simplified Nutritional Appetite Questionnaire (SNAQ).

OBJECTIVE: We aimed to investigate reliability and validity of the Turkish version of the Simplified Nutritional Appetite Questionnaire (SNAQ) in geriatric outpatients. DESIGN/SETTING: A cross-sectional study was designed through 2013-2016 years. At first, translation and back translation processes of the SNAQ from English to Turkish languages were done consecutively. Then construct validity was performed. PARTICIPANTS: They were recruited among the outpatients aged >=60 years that were consecutively admitted to the geriatric outpatient clinic of the Istanbul University hospital. MEASUREMENTS: Demographic data was recorded. SNAQ, Mini Nutritional Assessment (MNA), six-item Katz activities of daily living (ADL) and eight-item Lawton instrumental activities of daily living (IADL) scales were applied. RESULTS: 442 participants consisted of 305 women and 137 men with a mean age of 77.1 ± 6.8 years. The SNAQ identified 21.5% (n=95) of the participants with poor appetite. Reliability analysis showed good inter-rater reliability (r= 0.693, p< 0.05) and test-retest stability (r= 0.654, p< 0.05). Cronbach's alpha coefficient was 0.522. In terms of construct validity of SNAQ, Cohen's kappa analysis showed fair to moderate agreement between SNAQ and MNA (κ=0,355, p<0.001). Female gender, being illiterate, functional dependency in IADL were significantly associated with poor appetite. The SNAQ score was weakly correlated with scores of MNA-SF and MNA-LF (r=0.392 and r=0.380, respectively, p<0.0001 for both). There was statistically significantbut negligible correlation between the SNAQ and Katz ADL index, Lawton IADL index, and age. CONCLUSION: Turkish version of the SNAQ is a simple measurement with sufficient reliability and validity to screen poor appetite in community-dwelling older adults.

Performance of SARC-F in Regard to Sarcopenia Definitions, Muscle Mass and Functional Measures.

OBJECTIVE: To assess the reliability and validity of Turkish version of SARC-F in regard to screening with current definitions of sarcopenia, muscle mass and functional measures. DESIGN: Cross-sectional study. PARTICIPANTS: Community-dwelling older adults aged >=65 years admitting to a geriatric outpatient clinic. MEASUREMENTS: Muscle mass (bioimpedance analysis), handgrip strength, usual gait speed, chair sit-to-stand test, functional reach test, short physical performance battery, SARC-F questionnaire, FRAIL questionnaire Sarcopenia was evaluated with 4 current different definitions: European Working Group on Sarcopenia in Older People's (EWGSOP); Foundation for the National Institutes of Health (FNIH), International Working Group on Sarcopenia (IWGS) and Society on Sarcopenia, Cachexia and Wasting Disorders (SCWD). RESULTS: After cross-cultural adaptation, 207 subjects were analysed in the clinical validation study. Mean age was 74.6±6.7 years, 67.6% were women. Against EWGSOP, FNIH, IWGS and SCWD definitions of sarcopenia, sensitivity of SARC-F were %25, 31.6%, 50% and 40%; specificity were 81.4%, 82.4%, 81.8% and 81.7%, respectively. Positive predictive values were between 5.1-15.4% and negative predictive values were 92.3-98.2%. Against parameters of low muscle mass, sensitivity were about 20% and specificity were about 81%. Against parameters of function; for low hand grip strength, sensitivity of SARC-F were 33.7% (for Turkish cut-off); 50% (for FNIH cut-off); specificity were 93.7% (for Turkish cut-off) and 85.8% (for FNIH cut-off). Against low UGS, poor performance in chair sit to stand test, functional reach test, SPPB and presence of positive frailty screening sensitivity were 58.3%, 39.2%, 59.1%, 55.2% and 52.1% while specificity were 97.3%, 97.8%, 88.1%, 99.3% and 91.2%, respectively. CONCLUSION: The psychometric performance of Turkish SARC-F was similar to the original SARC-F. It revealed low sensitivity but high specificity with all sarcopenia definitions. Sensitivity and specificity were higher for muscle function tests reflecting its inquiry and input on functional measures. Our findings suggest that SARC-F is an excellent test to exclude muscle function impairment and sarcopenia. SARC-F is relatively a good screening test for functional measures.

Association of sociodemographic profile, dyslipidemias, and obesity in smoker, former smoker, and nonsmoker patients with coronary artery disease.

INTRODUCTION: In patients with established coronary artery disease (CAD), there are different reports on gender, age, dyslipidemia, and obesity according to smoking behavior. Smoking, obesity, and dyslipidemia are targets in secondary prevention. In this study, we aimed to investigate the sociodemographic differences, lipid profiles, body mass index (BMI), and cigarette smoking status in patients diagnosed with CAD. METHODS: Patients with records of angiography, smoking behavior, sociodemographic information, lipid levels, and BMI present at the outpatient visits were included in the study. Patients were grouped as active smokers, nonsmokers, and former smokers. Statistical methods were used for comparison of variables and means. RESULTS: A total of 235 patients, 167 (71.1%) men and 68 (28.9%) women, were included in the study. Nonsmokers group (31.4%) consisted of mostly women while active (22.6%) and former smoker (46%) groups consisted mostly of men (P < 0.0001). The mean age was 60.65 ± 11.55. Age was associated with the smoking status of patients, and nonsmokers consisted of geriatric patients significantly (P = 0.001). Educational status was associated with smoking history. Cessation of smoking after CAD diagnosis was achieved in 46% of patients. Active smokers had highest mean triglyceride (TG) values while nonsmokers had highest mean high-density lipoprotein-cholesterol (HDL-C) values. Active smokers had the highest mean TG values while nonsmokers had the highest mean HDL-C values. BMI was higher in nonsmokers than active smokers. CONCLUSION: Gender, age, and educational status are determinants of smoking behavior in patients with CAD. BMI is associated with smoking history. In nonsmokers, values of HDL were highest while TG values were lowest. To prevent reoccurring cardiovascular events, young patients and men are two groups which health professionals need to concentrate in motivating to quit smoking.