A Novel Tool in the Diagnosis and Follow-Up of (Cyclic) Cushing's Syndrome: Measurement of Long-Term Cortisol in Scalp Hair
A Novel Tool in the Diagnosis and Follow-Up of (Cyclic) Cushing's Syndrome: Measurement of Long-Term Cortisol in Scalp Hair
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DOI：
10.1210/jc.2012-1852
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发表时间：
2012-10-01
影响因子：
5.8
通讯作者：
van Rossum, E. F. C.
中科院分区：
文献类型：
--
作者：
Manenschijn, L.;Koper, J. W.;van Rossum, E. F. C.
背景：测量24小时尿液收集和午夜唾液中的皮质醇是库欣综合征（CS）的标准筛查试验。这些测试反映最多24小时内的皮质醇水平，不提供历史信息。因此，在循环CS的情况下，它们可以产生正常的结果，循环CS是一种罕见的疾病，其特征是内源性皮质醇过量和正常皮质醇分泌交替发作。头皮毛发中皮质醇的测量是一种新的工具，可能有助于建立（循环）CS的诊断。我们的目的是研究头发皮质醇时间线是否与CS患者的临床病程相对应，以及我们是否可以创建与疑似周期性CS患者的症状期相对应的皮质醇暴露的回顾性时间线。方法：收集14例确诊CS和6例疑似循环CS患者的头皮毛发。用甲醇从头发样品中提取皮质醇，并使用ELISA法测量头发提取物中的皮质醇水平。96名非肥胖者作为对照组。结果：CS患者毛发皮质醇水平显著升高（P < 0.0001）。毛发皮质醇测量对CS的敏感性和特异性分别为86%和98%。CS和循环CS患者的毛发皮质醇时间线与临床病程相对应。结论：头发样本可提供与（周期性）CS患者临床病程相对应的历史时间线。这种新的诊断工具对早期识别周期性CS患者具有重要意义。[J] .中华内分泌杂志，2012,31(5):389 - 389。
Background: Measurement of cortisol in 24-h urine collections and midnight saliva are standard screening tests for Cushing's syndrome (CS). These tests reflect cortisol levels during a maximum of 24 h and do not provide historical information. Therefore, they can yield normal results in case of cyclic CS, which is a rare disorder that is characterized by alternating episodes of endogenous cortisol excess and normal cortisol secretion. The measurement of cortisol in scalp hair is a novel tool that might be helpful to establish the diagnosis of (cyclic) CS. Our aim was to study whether hair cortisol timelines correspond with clinical course in patients with CS and whether we could create retrospective timelines of cortisol exposure that correspond with symptomatic periods in patients suspected of cyclic CS.Methods: Scalp hair was collected in 14 patients with confirmed CS and six patients suspected of cyclic CS. Cortisol was extracted from the hair samples with methanol, and an ELISA was used to measure cortisol levels in hair extracts. A group of 96 nonobese individuals were used as a control group.Results: Hair cortisol levels were significantly elevated in CS patients (P < 0.0001). Sensitivity and specificity of hair cortisol measurements for CS were 86 and 98%, respectively. Hair cortisol timelines of patients with CS and cyclic CS corresponded with clinical course.Conclusion: Hair samples can provide a historical timeline that corresponds with clinical course in patients with (cyclic) CS. This new diagnostic tool can contribute significantly to early recognition of patients suffering from cyclic CS. (J Clin Endocrinol Metab 97: E1836-E1843, 2012)