Steroid Profiling by IC-MS/MS in Nonsecreting and Subclinical Cortisol-Secreting Adrenocortical Adenomas
Steroid Profiling by IC-MS/MS in Nonsecreting and Subclinical Cortisol-Secreting Adrenocortical Adenomas
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DOI：
10.1210/jc.2015-1992
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发表时间：
2015-09-01
影响因子：
5.8
通讯作者：
Pasquali, Renato
中科院分区：
文献类型：
--
作者：
Di Dalmazi, Guido;Fanelli, Flaminia;Pasquali, Renato
背景：长期随访研究显示，肾上腺皮质腺瘤引起的亚临床高皮质醇症（SH）患者心血管疾病的发病率和死亡率增加。目的：本研究的目的是采用液相色谱-串联质谱法分析单侧肾上腺皮质腺瘤患者血清中的类固醇谱。设计：这是一项横断面研究。环境：研究在门诊进行。参与者：肾上腺皮质腺瘤患者（非分泌性，n = 66； SH, n = 28）和188名年龄和性别匹配的对照组，来自参与研究的普通人群。主要观察指标：测定基础状态和1-24 ACTH试验后的皮质醇、21-去氧皮质醇、11-去氧皮质醇、17-羟基孕酮、雄烯二酮、脱氢表雄酮、T、孕酮、11-去氧皮质酮、皮质酮及临床资料。结果：SH患者脱氢表雄酮和雄烯二酮的基础水平和1-24 acth刺激水平低于非分泌性腺瘤患者和对照组。SH女性的T也较低。受体工作特征曲线显示雄激素在预测SH方面具有良好的准确性（脱氢表雄酮的敏感性和特异性分别为71%和76%，雄烯二酮的敏感性和特异性分别为69%和61%）。皮质醇升高和脱氢表雄酮水平降低与腰围增加独立相关。皮质醇也与SH患者心血管危险因素的增加独立相关。在1-24 ACTH刺激后，SH患者也显示21-脱氧皮质醇和11-脱氧皮质酮的产生增加。结论：首次在肾上腺皮质腺瘤患者的血清中进行的液相色谱-串联质谱类固醇分析显示，SH患者的几种类固醇分泌受损。这种指纹可以帮助更好地表征这些肿瘤的功能状态。
Context: Long-term follow-up studies revealed that patients with subclinical hypercortisol ism (SH) due to adrenocortical adenomas have an increased incidence of cardiovascular diseases and mortality. No studies have yet investigated the steroid profile and its implications in patients with SH.Objective: The objective of the study was to analyze the steroid profile by liquid chromatography-tandem mass spectrometry in sera from patients with unilateral adrenocortical adenomas.Design: This was a cross-sectional study. Setting: The study was conducted at an outpatient clinic.Participants: Patients with adrenocortical adenomas (nonsecreting, n = 66; SH, n = 28) and 188 age- and sex-matched controls drawn from the general population participated in the study.Main Outcome Measures: Cortisol, 21-deoxycortisol, 11-deoxycortisol, 17-hydroxyprogesterone, androstenedione, dehydroepiandrosterone, T, progesterone, 11-deoxycorticosterone, and corticosterone in the basal condition and after a 1-24 ACTH test, and clinical data were measured.Results: Patients with SH showed lower basal and 1-24 ACTH-stimulated levels of dehydroepiandrosterone and androstenedione than those with nonsecreting adenomas and controls. T was also lower in SH females. Receiver-operating characteristic curves showed that androgens had good accuracy in predicting SH (sensitivity and specificity were 71% and 76% for dehydroepiandrosterone and 69% and 61% for androstenedione, respectively). Increased cortisol and reduced dehydroepiandrosterone levels were independently associated with increased waist circumference. Cortisol was also independently associated with increased number of cardiovascular risk factors in SH patients. After 1-24 ACTH stimulation, the SH patients also showed increased production of 21-deoxycortisol and 11-deoxycorticosterone.Conclusions: Liquid chromatography-tandem mass spectrometry steroid profile performed for the first time in sera from patients with adrenocortical adenomas showed impaired secretion of several steroids in SH patients. This fingerprint can help in better characterizing the functional status of these tumors.