The Physiology Of Hypercortisolism

虽然体重增加和肥胖几乎是Cushings综合征的普遍特征，但我们假设筛查结果在肥胖人群中的特异性很差。这项研究是在一家减肥诊所进行的，招募了至少有两种额外症状或体征的人。369名受试者(73%女性)完成了两项或三项测试：24小时尿皮质醇(UFC)和/或深夜唾液皮质醇，和/或1毫克地塞米松抑制试验(DST)。如果任何结果异常(基于DST和GT后的实验室参考范围或皮质醇；=1.8ug/dl 50nmol/L)，则重复测试和/或地塞米松-CRH(地塞米松-CRH)测试。DST结果异常且地塞米松水平低的受试者被要求重复服用2毫克地塞米松的测试。我们发现，除了肥胖，受试者还平均有5-6个库欣综合征的特征。没有人被发现患有库欣综合征。完成3次试验的受试者排除库欣综合征的特异度分别为：UFC 96%95 CI：93~98%；DST 90%95 CI：87~93%；RIA 95 CI：79~89%；LC-MS/MS 95 CI：92%。两种试验的所有组合的联合特异度(两种试验均正常)为84%至90%，有重叠的可信区间。这些数据不支持对超重和肥胖受试者进行库欣综合征的广泛筛查；对这类患者的检测结果可能是错误的异常。 在同一人群中，我们现在正在评估皮质醇对代谢综合征参数的影响。

Although weight gain and obesity are nearly universal features of Cushings syndrome, we hypothesized that screening results would have poor specificity in an obese population. The study is based in a weight loss clinic and enrolled individuals with at least two additional signs or symptoms of Cushings syndrome. 369 subjects (73% female) completed two or three tests: a 24h urine cortisol (UFC), and/or late-night salivary cortisol, and/or 1 mg dexamethasone suppression test (DST). If any result was abnormal (based on laboratory reference range or cortisol after DST >/= 1.8 ug/dl 50 nmol/l), tests were repeated and/or a dexamethasone-CRH (dex-CRH) test was performed. Subjects with abnormal DST results and a low dexamathasone level were asked to repeat the test with 2mg of dexamethasone. We found that in addition to obesity, subjects had a mean of 5-6 features of Cushing's syndrome. None was found to have Cushing's syndrome. Test specificities to exclude Cushing's syndrome for subjects who completed 3 tests were: UFC 96% 95 CI: 93-98%; DST 90% 95 CI: 87-93%; salivary cortisol 84% by RIA 95 CI: 79-89% and 92% by LC-MS/MS 95 CI: 88-95%. The combined specificity (both tests normal) for all combinations of two tests was 84 to 90%, with overlapping confidence intervals. These data do not support widespread screening of overweight and obese subjects for Cushing's syndrome; test results for such patients may be falsely abnormal. Within the same population we are now evaluating the influence of cortisol on parameters of the metabolic syndrome.