There are limited data linking diagnostic strategies to patient outcomes in Cushing's syndrome because “much of the work has focused on developing, validating, and ascertaining diagnostic test performance,” the authors wrote. As a result, “the evidence on which many of these recommendations have been made is of low to very low quality,” they stated. Additionally, the published data is potentially biased toward more severe cases with higher pretest probability, and thus might not accurately represent the tests' performance in unselected populations in usual clinical practice.
Possible research initiatives that could improve the future care of patients with Cushing's syndrome include the establishment of databases of consecutive patients tested for the syndrome, “allowing for prospective pooling of the diagnostic test information,” the authors wrote. Standardization of assays and improved clinical outcome data and targeted clinical trials are also on the authors' wish list.