Accurate tumor localization is necessary for the application of minimally invasive surgery, which is preferred in the treatment of primary hyperparathyroidism. Parathormone-washout (PTH-WO) is parathyroid fine-needle aspiration followed by PTH measurement in the needle washout fluid. This study aimed to determine appropriate cutoff values for the PTH-WO method. A total of 402 PTH-WO assays from 339 patients were included in the study. The diagnostic accuracy of the test was assessed by accepting as a positive result a PTH-WO result higher than the serum PTH level [PTH-WO/serum PTH(PTH ratio)>1]. In addition, a cutoff value for the test was established by evaluating the PTH washout results obtained in comparison with postoperative histopathology. Undiluted test results were not included to obtain a clear numerical value in this evaluation. The results of parathyroid scintigraphy and fine needle aspiration biopsy (FNAB) were compared with postoperative histopathology. While 309 (76.86%) of the PTH-WO procedures were considered positive, 93 (23.13%) were considered negative if the PTH ratio was > 1. When these results were compared with the postoperative histopathology, the test's sensitivity was 92.51%, and the specificity was 100.00%. In the analysis of the remaining 292 PTH-WO samples after excluding the undiluted ones, the sensitivity and specificity of the method were 92.3% and 94.1%, respectively, with a PTH ratio > 0.99. With a cutoff value of 99.5 ng/l for PTH-WO value, 93.1% sensitivity and 94.3% specificity were obtained. The sensitivities of parathyroid scintigraphy and FNAB were 53.4% and 15.3%, respectively. The PTH-WO method is safe and cheap, with high sensitivity and specificity in localizing parathyroid tumor. In cases where radiological methods cannot achieve localization with specified cutoff values, it has high diagnostic accuracy.

Our study aimed to discern disparities in metabolic, hormonal profiles, and comorbidities among patients with pituitary Cushing (PC), adrenal Cushing (AC), and Mild autonomous cortisol secretion (MACS). We conducted a retrospective analysis involving 76 patients diagnosed with PC (n = 26), AC (n = 21), and MACS (n = 29) at our clinic. We compared the groups' demographic data, clinical characteristics, biochemical profiles, hormonal analyses, and surgical interventions. No significant differences were noted in age, height, body mass index, or gender distribution among the groups, although a higher proportion of females was observed across all three groups. However, PC patients exhibited markedly elevated 24-hour urinary cortisol levels compared to AC and MACS patients. Furthermore, alanine aminotransferase, triglycerides, very low-density lipoprotein, insulin, and basal cortisol levels were significantly elevated in PC and AC cases compared to MACS cases. Interestingly, no significant differences were observed in terms of comorbidities among the groups. Our findings suggest that urinary cortisol levels were significantly higher in the PC group than in the AC and MACS groups, potentially indicating that high-amplitude adrenocorticotropic hormone stimulation may lead to increased cortisol secretion in PC patients. The increased utilization of imaging methods has facilitated the earlier detection of adrenal incidentalomas, enabling the diagnosis of adrenal Cushing's cases with milder cortisol elevations. Additionally, the severity of disease symptoms worsens with increasing cortisol levels.Notably, moderate increases in cortisol are associated with heightened comorbidities, underscoring the importance of vigilant management in Cushing's syndrome patients. Despite a lower degree of hypercortisolism in MACS, there were no differences in comorbidities, suggesting that even mild cortisol secretion abnormalities are sufficient to establish the presence of comorbidities. Even moderate increases in cortisol levels can impact bone metabolism.

Aims: We aimed to compare hormonal profiles, nutritional status, and bone health parameters among patients with Cushing’s disease (CD), adrenal Cushing syndrome (ACS), and mild autonomous cortisol secretion (MACS). Methods: A single-center, cross-sectional study was conducted involving 110 adults with confirmed endogenous Cushing syndrome (46 CD, 36 ACS, 28 MACS). Biochemical, hormonal, and nutritional parameters (assessed via Prognostic Nutritional Index [PNI] and Controlling Nutritional Status [CONUT] scores) were evaluated alongside BMD (dual-energy X-ray absorptiometry [DXA]) and 10-year fracture risk (FRAX®). Results: The cohort (median age:53 years; 83.6% female) demonstrated expected hormonal variations among CS subtypes. However, all groups were similar in terms of PNI, CONUT score, and (dys) nutritional states. Bone health analysis revealed similar BMD and FRAX® scores across groups, except for higher femoral neck Z-scores in MACS versus ACS (p=0.027). Osteoporosis (present in 38.2% overall) was associated with worse DXA parameters and elevated fracture risk (p

Background/Objectives: Cushing’s syndrome (CS) is a rare endocrine disorder caused by chronic glucocorticoid excess. With the increasing recognition of mild autonomous cortisol secretion (MACS), clinical and biochemical differentiation between overt and mild forms has become more challenging. This study evaluated the clinical significance of the hemoglobin–albumin–lymphocyte–platelet (HALP) score in patients with Cushing’s disease (CD), adrenal Cushing’s syndrome (ACS), MACS, and nonfunctioning adrenal adenoma (NFA), focusing on its potential role in the preoperative evaluation and postoperative follow-up of hypercortisolism. Methods: We retrospectively analyzed 361 patients evaluated for cortisol excess between February 2019 and June 2025. Patients were categorized into four groups: CD, ACS, MACS, and NFA. Demographic, clinical, and hormonal parameters, as well as surgical outcomes, were recorded, and the HALP score was compared between the four groups. The diagnostic performance of the HALP score in differentiating overt Cushing’s syndrome (CD + ACS) from MACS/NFA was assessed using receiver operating characteristic (ROC) curve analysis. Postoperative changes in the HALP score were analyzed in surgically treated patients. Results: HALP scores were significantly lower in overt CS than in MACS and NFA. Using a threshold value of 40, the HALP score demonstrated 51.9% sensitivity and 90.4% specificity in differentiating CD/ACS from MACS/NFA. Among 68 operated patients, postoperative HALP data were available for 49 patients, for whom HALP scores significantly increased in both CD and ACS groups (p = 0.001 for each). Conclusions: The HALP score serves as a simple, cost-effective biomarker that reflects the combined hematologic and metabolic impact of cortisol excess. Significant postoperative improvement in the HALP score suggests its potential utility as a complementary tool in the preoperative assessment of hypercortisolism.