Görges R, Knappe G, Gerl H, Ventz M, Stahl F
Department of Internal Medicine IV, Klinikum der Universität GH Essen, Germany.
J Endocrinol Invest. 1999 Apr;22(4):241-9. doi: 10.1007/BF03343551.
We studied plasma cortisol levels at 00:00 h and 08:00 h in 103 patients with Cushing's syndrome and 144 patients in whom this diagnosis had been excluded. These patients were hospitalized in our department from 1975 to 1996. Additionally, we measured these parameters in 20 healthy volunteers and in 5 patients with nonendocrine disease. Corresponding data of urinary free cortisol and low-dose dexamethasone suppression testing were included in the evaluation. Values (mean+/-SD) from patients with Cushing's syndrome: 510+/-232 nmol/l (range 165-1488) for plasma cortisol 00:00 h, 574+/-242 nmol/l (range 236-1612) for plasma cortisol 08:00 h, 991+/-885 nmol/24 h (range 154-4866) for urinary free cortisol and 479+/-304 nmol/l (range 34 - 1,393) for plasma cortisol after 1.5 mg dexamethasone. Values from the patients excluded from Cushing's syndrome: 99+/-76 nmol/l (range 5-371) for plasma cortisol 00:00 h, 393+/-136 nmol/l (range 119-812) for plasma cortisol 08:00 h, 126+/-84 nmol/24 h (range 30-485) for urinary free cortisol, and 64+/-82 nmol/l (range 5-395) for plasma cortisol after 1.5 mg dexamethasone. Values of the healthy volunteers respectively patients with non-endocrine disease: 59+/-30 nmol/l (range 25-130) respectively 127+/-80 nmol/l (range 62-265) for plasma cortisol 00:00 h and 388+/-144 nmol/l (range 157-651) respectively 498+/-113 nmol/l (range 302-581) for plasma cortisol 08:00 h. None of the Cushing patients exhibited a 00:00 h plasma cortisol below 140 nmol/l and only one had a urinary free cortisol below 200 nmol/24 h, whereas 4 were complete dexamethasone suppressors. The diagnostic value of these parameters was examined based on various cutoffs. We recommend determination of midnight plasma cortisol as an efficient and simple additional procedure for the diagnosis of Cushing's syndrome. The sensitivity and specificity of this procedure is similar to urinary free cortisol and slightly above the low-dose dexamethasone suppression testing in our hospitalized patients.
我们研究了103例库欣综合征患者和144例已排除该诊断的患者在00:00时和08:00时的血浆皮质醇水平。这些患者于1975年至1996年在我们科室住院。此外，我们还测量了20名健康志愿者和5例非内分泌疾病患者的这些参数。尿游离皮质醇和小剂量地塞米松抑制试验的相应数据也纳入了评估。库欣综合征患者的值（均值±标准差）：00:00时血浆皮质醇为510±232 nmol/l（范围165 - 1488），08:00时血浆皮质醇为574±242 nmol/l（范围236 - 1612），尿游离皮质醇为991±885 nmol/24 h（范围154 - 4866），1.5 mg地塞米松后血浆皮质醇为479±304 nmol/l（范围34 - 1393）。排除库欣综合征的患者的值：00:00时血浆皮质醇为99±76 nmol/l（范围5 - 371），08:00时血浆皮质醇为393±136 nmol/l（范围119 - 812），尿游离皮质醇为126±84 nmol/24 h（范围30 - 485），1.5 mg地塞米松后血浆皮质醇为64±82 nmol/l（范围5 - 395）。健康志愿者和非内分泌疾病患者的值：00:00时血浆皮质醇分别为59±30 nmol/l（范围25 - 130）和127±80 nmol/l（范围62 - 265），08:00时血浆皮质醇分别为388±144 nmol/l（范围157 - 651）和498±113 nmol/l（范围302 - 581）。没有库欣患者00:00时血浆皮质醇低于140 nmol/l，只有1例尿游离皮质醇低于200 nmol/24 h，而4例为完全地塞米松抑制者。基于各种临界值检查了这些参数的诊断价值。我们建议测定午夜血浆皮质醇作为诊断库欣综合征的一种有效且简单的附加程序。在我们的住院患者中，该程序的敏感性和特异性与尿游离皮质醇相似，略高于小剂量地塞米松抑制试验。
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