{"id":56057,"date":"2026-07-02T10:02:46","date_gmt":"2026-07-02T08:02:46","guid":{"rendered":"https:\/\/www.mylav.net\/?p=56057"},"modified":"2026-07-02T16:27:43","modified_gmt":"2026-07-02T14:27:43","slug":"syndrome-de-cushing-chez-le-chien-pourquoi-le-seuil-diagnostique-du-test-de-freinage-a-la-dexamethasone-faible-dose-lddst-doit-etre-mis-a-jour","status":"publish","type":"post","link":"https:\/\/www.mylav.net\/fr\/endocrinologie\/syndrome-de-cushing-chez-le-chien-pourquoi-le-seuil-diagnostique-du-test-de-freinage-a-la-dexamethasone-faible-dose-lddst-doit-etre-mis-a-jour\/","title":{"rendered":"Syndrome de Cushing chez le chien : pourquoi le seuil diagnostique du test de freinage \u00e0 la dexam\u00e9thasone faible dose (LDDST) doit \u00eatre mis \u00e0 jour"},"content":{"rendered":"

Le test de freinage \u00e0 la dexam\u00e9thasone faible dose (<\/span>low dose dexamethasone suppression test<\/span><\/i>, LDDST) est l’un des tests endocriniens les plus utilis\u00e9s en pratique clinique pour le diagnostic de l’hypercorticisme (syndrome de Cushing) chez le chien.<\/span><\/p>\n

Pendant des ann\u00e9es, la valeur de cortisol \u00e0 8 heures (T8) d\u00e9finissant un LDDST positif \u00e9tait <\/span>> 1,4 \u03bcg\/dL.<\/b><\/p>\n

Ce seuil remonte \u00e0 une \u00e9tude men\u00e9e il y a plus de quarante ans, bas\u00e9e sur une technique (radio-immunodosage, RIA) diff\u00e9rente de celle largement utilis\u00e9e aujourd’hui (immuno-analyse par chimiluminescence, CLIA).<\/span><\/p>\n

Un seuil diagnostique \u00e0 r\u00e9viser<\/b><\/h2>\n

La Soci\u00e9t\u00e9 europ\u00e9enne d’endocrinologie v\u00e9t\u00e9rinaire (ESVE) et la BSAVA recommandent de revalider les seuils diagnostiques pour l’hypercortisolisme et l’hypoadr\u00e9nocorticisme, notamment au regard des modifications r\u00e9centes apport\u00e9es aux nouveaux kits diagnostiques du fabricant.<\/span><\/p>\n

Une \u00e9tude d\u00e9di\u00e9e<\/b><\/h2>\n

Le groupe de recherche en endocrinologie de l’Universit\u00e9 de Bologne a conduit une \u00e9tude r\u00e9trospective publi\u00e9e r\u00e9cemment dans l’<\/span>American Journal of Veterinary Research<\/span><\/i>, portant sur 183 chiens ayant subi un LDDST entre 2016 et 2024 : 93 test\u00e9s avec l’ancien kit, 80 avec un nouveau kit diagnostique.<\/span><\/p>\n

Le groupe \u00ab malades \u00bb comprenait des chiens avec un diagnostic confirm\u00e9 de syndrome de Cushing ; le groupe contr\u00f4le \u00e9tait constitu\u00e9 de chiens pr\u00e9sentant des affections mimant le syndrome de Cushing, c’est-\u00e0-dire des patients avec des signes cliniques compatibles mais un diagnostic final diff\u00e9rent. Un choix qui refl\u00e8te le sc\u00e9nario clinique r\u00e9el dans lequel le LDDST est utilis\u00e9.<\/span><\/p>\n

Le r\u00e9sultat qui int\u00e9resse le clinicien<\/b><\/h2>\n

Les r\u00e9sultats de l’\u00e9tude montrent qu’avec le nouvel anticorps, le seuil optimal \u00e0 T8 pour distinguer les chiens atteints du syndrome de Cushing des chiens pr\u00e9sentant d’autres affections est de > 1,2 \u03bcg\/dL, avec une sensibilit\u00e9 de 92,5 % et une sp\u00e9cificit\u00e9 de 95,0 %.<\/b><\/p>\n

En revanche, en conservant l’ancien seuil de 1,4 \u03bcg\/dL, le test perd en sensibilit\u00e9 (Figure 1).<\/b><\/p>\n

\"\"
Figure 1. Performances diagnostiques du LDDST avec le nouvel anticorps Immulite 2000XPi (groupe NA, n = 80). Le graphique repr\u00e9sente la sensibilit\u00e9 et la sp\u00e9cificit\u00e9 du test aux diff\u00e9rents seuils T8. Donn\u00e9es issues de la Tab. 3 de Rossi et al., 2026.<\/figcaption><\/figure>\n

En pratique<\/b><\/h2>\n

Utiliser l’ancien seuil avec le nouveau kit revient \u00e0 manquer une proportion non n\u00e9gligeable de chiens effectivement malades (r\u00e9duction de la sensibilit\u00e9 diagnostique).<\/b><\/p>\n

C’est le cas en particulier pour les formes pr\u00e9coces ou \u00e0 pr\u00e9sentation clinique ambigu\u00eb, cas que l’on rencontre de plus en plus souvent gr\u00e2ce \u00e0 une meilleure connaissance du syndrome de Cushing.<\/span><\/p>\n

\u00c0 retenir<\/b><\/h2>\n

Il est aujourd’hui recommand\u00e9 de mettre \u00e0 jour le seuil T8 et de consid\u00e9rer le LDDST comme positif \u00e0 partir de <\/span>> 1,2 \u03bcg\/dL<\/b>, et non plus 1,4 \u03bcg\/dL. Conserver l’ancien seuil revient \u00e0 manquer une partie des chiens r\u00e9ellement atteints, en particulier dans les cas pr\u00e9coces.<\/span><\/p>\n

Deux autres points importants m\u00e9ritent d’\u00eatre soulign\u00e9s :<\/b><\/h2>\n
    \n
  1. La s\u00e9lection rigoureuse du patient est indispensable : le LDDST doit \u00eatre r\u00e9alis\u00e9 chez des chiens avec une probabilit\u00e9 pr\u00e9-test \u00e9lev\u00e9e (donn\u00e9es anamnestiques, examen clinique et anomalies clinicopathologiques compatibles avec un hypercorticisme).<\/span><\/li>\n
  2. Les r\u00e9sultats du LDDST doivent toujours \u00eatre int\u00e9gr\u00e9s aux donn\u00e9es anamnestiques et aux r\u00e9sultats des autres examens compl\u00e9mentaires (bilan de base, analyse d’urine, autres tests endocriniens et imagerie), car aucun test isol\u00e9 ne permet \u00e0 lui seul de diagnostiquer un syndrome de Cushing.<\/span><\/li>\n<\/ol>\n

    Bibliographie<\/b><\/h2>\n
      \n
    1. Rossi G, Del Baldo F, Tardo AM, Golinelli S, Fracassi F. <\/span>Immunoassay antibody modification significantly impacts low-dose dexamethasone suppression test cutoffs in dogs with Cushing syndrome. Am J Vet Res. 2026. doi:10.2460\/ajvr.25.12.0451<\/span><\/i><\/li>\n
    2. Changes in canine cortisol measurement. European Society of Veterinary Endocrinology and British Small Animal Veterinary Association. Accessed January 13, 2026. <\/span>https:\/\/www.esve.org\/news\/2020\/20201109cortisolmeasurement_ESVE-BSAVA_Release_Nov2020.pdf<\/span><\/a><\/li>\n<\/ol>\n

      Antonio Maria Tardo<\/b>, DMV, EBVS European Specialist in Veterinary Internal Medicine (Dipl. ECVIM-CA) ; Expert MYLAV en M\u00e9decine Interne<\/span><\/p>\n

      Walter Bertazzolo<\/b>, DMV, EBVS European Specialist in Veterinary Clinical Pathology (Dipl. ECVCP) ; Directeur Scientifique de MYLAV<\/span><\/p>\n

      Picture :\u00a0https:\/\/www.magnific.com\/<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

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