Diagnostic Accuracy of Dehydroepiandrosterone Sulfate and Corticotropin in Autonomous Cortisol Secretion.
Diagnostic Accuracy of Dehydroepiandrosterone Sulfate and Corticotropin in Autonomous Cortisol Secretion.
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DOI：
10.3390/biomedicines9070741
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发表时间：
2021-06-28
期刊：
影响因子：
4.7
通讯作者：
Bancos I
中科院分区：
文献类型：
--
作者：
Carafone LE;Zhang CD;Li D;Lazik N;Hamidi O;Hurtado MD;Young WF Jr;Thomas MA;Dy BM;Lyden ML;Foster TR;McKenzie TJ;Bancos I
自主性皮质醇分泌（ACS）影响高达50%的肾上腺腺瘤患者。尽管证据有限，但临床指南建议测量硫酸脱氢表雄酮（DHEA-S）和促肾上腺皮质激素（ACTH）的血清浓度，以帮助诊断ACS。我们的目的是确定血清DHEA-S和ACTH浓度诊断ACS的准确性。我们对2000 - 2020年间评估的成人肾上腺腺瘤患者进行了回顾性单中心研究。主要结果指标是DHEA-S和ACTH的诊断准确性。ACS定义为地塞米松后皮质醇>1.8 mcg/dL。在468例患者中，256例（55%）患者诊断为ACS，DST后皮质醇中位数为3.45 mcg/dL（范围，1.9-32.7）。与无功能肾上腺肿瘤（NFAT）患者相比，ACS患者的DHEA-S（35 vs. 87.3 mcg/dL，p < 0.0001）和ACTH（8.3 vs. 16 pg/mL，p < 0.0001）血清浓度较低。血清DHEA-S浓度<40 mcg/dL诊断ACS的特异性为84%，PPV为81%，而血清ACTH浓度<10 pg/mL诊断ACS的特异性为75%，PPV为78%。DHEA-S <40微克/分升和ACTH <10微克/毫升的血清浓度组合诊断ACS的准确性最高，特异性为92%，PPV为87%。血清DHEA-S和ACTH浓度在诊断ACS中提供了额外的价值。
Autonomous cortisol secretion (ACS) affects up to 50% of patients with adrenal adenomas. Despite the limited evidence, clinical guidelines recommend measurement of serum concentrations of dehydroepiandrosterone-sulfate (DHEA-S) and corticotropin (ACTH) to aid in the diagnosis of ACS. Our objective was to determine the accuracy of serum concentrations of DHEA-S and ACTH in diagnosing ACS. We conducted a retrospective single center study of adults with adrenal adenoma evaluated between 2000−2020. Main outcome measure was diagnostic accuracy of DHEA-S and ACTH. ACS was defined as post-dexamethasone cortisol >1.8 mcg/dL. Of 468 patients, ACS was diagnosed in 256 (55%) patients with a median post-DST cortisol of 3.45 mcg/dL (range, 1.9–32.7). Patients with ACS demonstrated lower serum concentrations of DHEA-S (35 vs. 87.3 mcg/dL, p < 0.0001) and ACTH (8.3 vs. 16 pg/mL, p < 0.0001) compared to patients with non-functioning adrenal tumors (NFAT). Serum DHEA-S concentration <40 mcg/dL diagnosed ACS with 84% specificity and 81% PPV, while serum ACTH concentration <10 pg/mL diagnosed ACS with 75% specificity and 78% PPV. The combination of serum concentrations of DHEA-S <40 mcg/dL and ACTH <10 pg/mL diagnosed ACS with the highest accuracy with 92% specificity and 87% PPV. Serum concentrations of DHEA-S and ACTH provide additional value in diagnosing ACS.
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影响因子：
2.9
作者：
Ueland GÅ;Grinde T;Methlie P;Kelp O;Løvås K;Husebye ES
通讯作者：
Husebye ES
影响因子：
5.8
作者：
Reimondo, Giuseppe;Castellano, Elena;Terzolo, Massimo
通讯作者：
Terzolo, Massimo
影响因子：
5.8
作者：
Mantero, F;Terzolo, M;Angeli, A
通讯作者：
Angeli, A
影响因子：
3.7
作者：
Patrova, Jekaterina;Kjellman, Magnus;Falhammar, Henrik
通讯作者：
Falhammar, Henrik
DOI：
10.1016/s2213-8587(20)30314-4
发表时间：
2020-11
期刊：
The lancet. Diabetes & endocrinology
影响因子：
--
作者：
Ebbehoj A;Li D;Kaur RJ;Zhang C;Singh S;Li T;Atkinson E;Achenbach S;Khosla S;Arlt W;Young WF;Rocca WA;Bancos I
通讯作者：
Bancos I