Consensus on biomarker utility for ACTH-dependent Cushing syndrome: a Pituitary Society Modified Delphi Panel

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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.