评估大剂量地塞米松抑制试验在确诊库欣病中的效用。

Assessment of the utility of the high-dose dexamethasone suppression test in confirming the diagnosis of Cushing disease.

机构信息

Department of Endocrinology, Crystal Run Healthcare, Middletown, New York, USA.

出版信息

Endocr Pract. 2012 Mar-Apr;18(2):152-7. doi: 10.4158/EP11179.OR.

DOI:10.4158/EP11179.OR

PMID:21856594

Abstract

OBJECTIVE

To determine the utility of high-dose dexamethasone suppression (HDDS) tests to confirm the diagnosis of Cushing disease (CD).

METHODS

In this retrospective study, we reviewed medical records of patients who underwent either the overnight 8-mg HDDS test or the 2-day 2-mg HDDS test every 6 hours. The percentage suppression of morning serum cortisol and the percentage suppression of 24-hour urine free cortisol (UFC) were calculated.

RESULTS

Of 141 patients with proven CD who underwent HDDS tests, 77 (55%) underwent the overnight 8-mg HDDS test and 64 (45%) underwent the 2-day 2-mg HDDS test every 6 hours. With the overnight 8-mg HDDS test, 73 of 77 patients (95%) had greater than 50% suppression and 48 of 77 patients (62%) had greater than 80% suppression of the morning serum cortisol in comparison with the baseline value. With the 2-day 2-mg HDDS test, only 41 of 64 patients (64%) had greater than 90% suppression of 24-hour UFC.

CONCLUSION

We conclude that the overnight 8-mg HDDS test accurately confirmed the diagnosis of CD with a high sensitivity of 95% with use of a criterion of greater than 50% suppression; in contrast, the sensitivity was only 62% with use of a more precise cutoff of greater than 80% suppression. The 2-day 2-mg HDDS test with a criterion of greater than 90% suppression of 24-hour UFC had a sensitivity of 64%. These results confirm the limited precision of the HDDS tests.

摘要

目的

确定大剂量地塞米松抑制（HDDS）试验在确诊库欣病（CD）中的作用。

方法

在这项回顾性研究中，我们对接受过夜 8mg HDDS 试验或每 6 小时进行 2 天 2mg HDDS 试验的患者的病历进行了回顾。计算清晨血清皮质醇的抑制百分比和 24 小时尿游离皮质醇（UFC）的抑制百分比。

结果

在接受 HDDS 试验的 141 例确诊 CD 的患者中，77 例（55%）接受过夜 8mg HDDS 试验，64 例（45%）接受每 6 小时 2 天 2mg HDDS 试验。在过夜 8mg HDDS 试验中，与基线值相比，77 例患者中有 73 例（95%）的清晨血清皮质醇抑制率大于 50%，48 例（62%）的抑制率大于 80%。在 2 天 2mg HDDS 试验中，仅有 64 例患者中的 41 例（64%）的 24 小时 UFC 抑制率大于 90%。

结论

我们得出结论，使用大于 50%抑制率的标准，过夜 8mg HDDS 试验能准确确诊 CD，灵敏度高达 95%；相比之下，使用更精确的大于 80%抑制率的标准，灵敏度仅为 62%。使用大于 90%抑制率的 24 小时 UFC 的 2 天 2mg HDDS 试验的灵敏度为 64%。这些结果证实了 HDDS 试验的精度有限。