Dexamethasone measurement during low-dose suppression test for suspected hypercortisolism: threshold development with and validation
Dexamethasone measurement during low-dose suppression test for suspected hypercortisolism: threshold development with and validation
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DOI：
10.1007/s40618-020-01197-6
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发表时间：
2020-02-14
影响因子：
5.4
通讯作者：
Scaroni, C.
中科院分区：
文献类型：
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作者：
Ceccato, F.;Artusi, C.;Scaroni, C.
背景与目的地塞米松抑制试验（DST）用于库欣综合征（CS）诊断，探讨垂体对糖皮质激素的反馈。其诊断准确性可能受到地塞米松生物利用度的影响，因此，我们开发并验证了1 mg DST后地塞米松阈值。材料和方法我们研究了200名受试者：125名患者回顾性研究，75名患者前瞻性纳入验证队列。采用LC-MS/MS法测定血清地塞米松、深夜唾液皮质醇（LNSC）和尿游离皮质醇（UFC）。使用正常的LNSC和UFC水平来排除CS。1 mg DST后皮质醇为138 nmol/L的非cs患者地塞米松分布较低2.5百分位。结论：我们开发并验证了1 mg DST期间的常规地塞米松测量：它与患者的临床表现无关，应用于提高血清皮质醇水平的特异性。
Background and aim Dexamethasone Suppression Test (DST), recommended for Cushing's Syndrome (CS) diagnosis, explores the pituitary feedback to glucocorticoids. Its diagnostic accuracy could be affected by dexamethasone bioavailability, and therefore, we have developed and validated a dexamethasone threshold after 1-mg DST. Materials and methods We studied 200 subjects: 125 patients were considered retrospectively and 75 were enrolled prospectively as the validation cohort. Serum dexamethasone, Late Night Salivary Cortisol (LNSC), and Urinary Free Cortisol (UFC) were measured with LC-MS/MS. Normal LNSC and UFC levels were used to exclude CS. The lower 2.5th percentile of dexamethasone distribution in non-CS patients with cortisol 138 nmol/L after 1-mg DST). Conclusions We developed and validated the routine dexamethasone measurement during 1-mg DST: it is independent from patient's clinical presentation, and it should be used to increase the specificity of serum cortisol levels.