Diagnostic testing of autonomous cortisol secretion in adrenal incidentalomas.
Diagnostic testing of autonomous cortisol secretion in adrenal incidentalomas.
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DOI：
10.1530/ec-20-0419
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发表时间：
2020-10
影响因子：
2.9
通讯作者：
Husebye ES
中科院分区：
文献类型：
--
作者：
Ueland GÅ;Grinde T;Methlie P;Kelp O;Løvås K;Husebye ES
自主性皮质醇分泌（ACS）是一种肾上腺偶发瘤（AI）或肾上腺增生导致的ACTH非依赖性皮质醇过度分泌的疾病。皮质醇增多症常为轻度，大多数患者缺乏明显的库欣综合征（CS）的典型临床特征。ACS没有很好的定义，诊断测试缺乏验证。回顾性研究165例AI患者的临床评价和测定早晨血浆ACTH，深夜唾液皮质醇，血清硫酸脱氢表雄酮（DHEAS），24小时尿游离皮质醇，地塞米松抑制后皮质醇。根据现行欧洲指南，AI患者（n = 165）被诊断为无功能偶发瘤（NFI）（n = 82）或ACS（n = 83）。深夜唾液皮质醇对NFI和ACS的区分能力较差，假阳性（23/63）和假阴性（38/69）结果的发生率很高。常规小剂量地塞米松抑制试验（LDDST）与1 mg过夜DST相比，未提高诊断特异性。两个队列中DHEAS的受试者工作特征曲线分析显示，曲线下面积为0.76（P < 0.01），ACS的敏感性为58%，特异性为80%，推荐的临界值为1.04 µmol/L（40 µg/dL）。我们在这里证明，在一个大的回顾性队列的偶发瘤患者，无论是DHEAS，深夜唾液皮质醇或24小时尿游离皮质醇是有用的区分无功能肾上腺偶发瘤和ACS。与1 mg过夜DST相比，常规LDDST未增加更多信息。需要替代的生物标志物来改善ACS的诊断检查。
Autonomous cortisol secretion (ACS) is a condition with ACTH-independent cortisol overproduction from adrenal incidentalomas (AI) or adrenal hyperplasia. The hypercortisolism is often mild, and most patients lack typical clinical features of overt Cushing’s syndrome (CS). ACS is not well defined and diagnostic tests lack validation. Retrospective study of 165 patients with AI evaluated clinically and by assay of morning plasma ACTH, late-night saliva cortisol, serum DHEA sulphate (DHEAS), 24-h urine-free cortisol, and cortisol after dexamethasone suppression. Patients with AI (n = 165) were diagnosed as non-functioning incidentalomas (NFI) (n = 82) or ACS (n = 83) according to current European guidelines. Late-night saliva cortisol discriminated poorly between NFI and ACS, showing a high rate of false-positive (23/63) and false-negative (38/69) results. The conventional low-dose dexamethasone suppression test (LDDST) did not improve the diagnostic specificity, compared with the 1 mg overnight DST. Receiver operating characteristic curve analysis of DHEAS in the two cohorts demonstrated an area under the curve of 0.76 (P < 0.01) with a sensitivity for ACS of 58% and a specificity of 80% using the recommended cutoff at 1.04 µmol/L (40 µg/dL). We here demonstrate in a large retrospective cohort of incidentaloma patients, that neither DHEAS, late-night saliva cortisol nor 24-h urine free cortisol are useful to discriminate between non-functioning adrenal incidentalomas and ACS. The conventional LDDST do not add further information compared with the 1 mg overnight DST. Alternative biomarkers are needed to improve the diagnostic workup of ACS.