Salivary Cortisol and Cortisone After Low-Dose Corticotropin Stimulation in the Diagnosis of Adrenal Insufficiency.
Salivary Cortisol and Cortisone After Low-Dose Corticotropin Stimulation in the Diagnosis of Adrenal Insufficiency.
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DOI：
10.1210/js.2016-1056
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发表时间：
2017-02-01
影响因子：
4.1
通讯作者：
Tiu SC
中科院分区：
文献类型：
--
作者：
Mak IYF;Au Yeung BYT;Ng YW;Choi CH;Iu HYP;Shek CC;Tiu SC
基础和刺激后唾液皮质醇和可的松水平可用于诊断肾上腺功能不全。然而，人们对这些测试的最佳截止值和性能特征知之甚少。推导临界值并研究唾液皮质醇和唾液可的松在诊断肾上腺皮质功能减退症中的表现特征。 2014年1月至2015年9月在香港一家地区医院进行的前瞻性研究。56名中国健康志愿者和171名疑似肾上腺功能不全的患者。所有参与者均接受了低剂量短时 Synacthen 试验 (LDSST)，静脉注射 1 μg 四十二肽 (Synacthen 1-24)。在基线以及30分钟和60分钟后测量血清皮质醇、唾液皮质醇和可的松水平。使用来自健康志愿者的参考截止值（LDSST 后血清皮质醇峰值的平均值 - 2 个标准差）作为金标准，对患者数据的接收者操作特征分析显示，LDSST 后唾液皮质醇峰值和可的松的表现均优于基础测试。通过免疫测定法测量的血清皮质醇以及通过液相色谱-串联质谱法 (LC-MS/MS) 测量的唾液皮质醇和唾液可的松的最佳截止值分别为 LDSST 后峰值 376、8.6 和 33.5 nmol/L，基础值分别为 170、1.7 和 12.5 nmol/L。我们在 LDSST 期间建立了血清皮质醇、唾液皮质醇和唾液可的松的方法特定参考临界值。 LDSST 后唾液皮质醇峰值和可的松在肾上腺功能不全的诊断测试中均表现良好。他们通过 LC-MS/MS 进行的测量可以缓解与血清皮质醇免疫测定相关的问题。建立了短 Synacthen 测试 (SST) 中血清皮质醇、唾液皮质醇和唾液可的松的参考临界值。两项 SST 后唾液测试在诊断肾上腺功能不全方面均表现良好。
Basal and poststimulation salivary cortisol and cortisone levels can be useful in the diagnosis of adrenal insufficiency. However, little is known about the optimal cutoffs and performance characteristics of these tests. To derive the cutoff values and study the performance characteristics of salivary cortisol and salivary cortisone in the diagnosis of adrenal insufficiency. Prospective study in a regional hospital in Hong Kong from January 2014 to September 2015. Fifty-six Chinese healthy volunteers and 171 patients suspected of having adrenal insufficiency. All participants underwent low-dose short Synacthen test (LDSST) with intravenous injection of 1 μg of tetracosactide (Synacthen 1–24). Serum cortisol, salivary cortisol and cortisone levels were measured at baseline and 30 and 60 minutes afterward. Using the reference cutoff (mean − 2 standard deviations of post-LDSST peak serum cortisol) derived from healthy volunteers as the gold standard, receiver operating characteristic analysis of patients’ data revealed that both post-LDSST peak salivary cortisol and cortisone performed better than basal tests. The most optimal cutoff values for serum cortisol as measured by immunoassay and for salivary cortisol and salivary cortisone as measured by liquid chromatography–tandem mass spectrometry (LC-MS/MS) were 376, 8.6, and 33.5 nmol/L, respectively, for post-LDSST peak values, and 170, 1.7, and 12.5 nmol/L, respectively, for basal values. We established method-specific reference cutoffs for serum cortisol, salivary cortisol, and salivary cortisone during LDSST. Both post-LDSST peak salivary cortisol and cortisone performed well as diagnostic tests for adrenal insufficiency. Their measurements by LC-MS/MS can alleviate problems associated with serum cortisol immunoassays. Reference cutoffs for serum cortisol, salivary cortisol, and salivary cortisone in a short Synacthen test (SST) were established. Both post-SST salivary tests performed well in diagnosing adrenal insufficiency.