Dennedy M Conall, Annamalai Anand K, Prankerd-Smith Olivia, Freeman Natalie, Vengopal Kuhan, Graggaber Johann, Koulouri Olympia, Powlson Andrew S, Shaw Ashley, Halsall David J, Gurnell Mark
Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, and Departments of.
Radiology, and.
J Clin Endocrinol Metab. 2017 Mar 1;102(3):786-792. doi: 10.1210/jc.2016-2718.
Subclinical hypercortisolism (SH) occurs in 5% to 30% of adrenal incidentalomas (AIs). Common screening tests for adrenocorticotropin-independent hypercortisolism have substantial false-positive rates, mandating further time and resource-intensive investigations.
To determine whether low basal dehydroepiandrosterone sulfate (DHEAS) is a sensitive and specific screening test for SH in AI.
In total, 185 patients with AI were screened for adrenal medullary (plasma metanephrines) and cortical [1 mg overnight dexamethasone suppression test (ONDST), 24-hour urinary free cortisol (UFC), serum DHEAS, plasma renin, and aldosterone] hyperfunction. Positive ONDST [≥1.8 mcg/dL (≥50 nmol/L)] and/or UFC (more than the upper limit of reference range) results were further investigated. We diagnosed SH when at least 2 of the following were met: raised UFC, raised midnight serum cortisol, 48-hour dexamethasone suppression test (DST) cortisol ≥1.8 mcg/dL (≥50 nmol/L).
29 patients (16%) were diagnosed with SH. Adrenocorticotropin was <10 pg/mL (<2.2 pmol/L) in all patients with SH. We calculated age- and sex-specific DHEAS ratios (derived by dividing the DHEAS by the lower limit of the respective reference range) for all patients. Receiver operating characteristic curve analyses demonstrated that a ratio of 1.12 was sensitive (>99%) and specific (91.9%) for the diagnosis of SH. Cortisol following 1 mg ONDST of 1.9 mcg/dL (53 nmol/L) was a sensitive (>99%) screening test for SH but had lower specificity (82.9%). The 24-hour UFC lacked sensitivity (69%) and specificity (72%).
A single basal measurement of DHEAS offers comparable sensitivity and greater specificity to the existing gold-standard 1 mg DST for the detection of SH in patients with AIs.
亚临床皮质醇增多症（SH）在5%至30%的肾上腺偶发瘤（AI）中出现。用于诊断不依赖促肾上腺皮质激素的皮质醇增多症的常见筛查试验有相当高的假阳性率，这就需要进一步进行耗时且资源密集的检查。
确定低基础硫酸脱氢表雄酮（DHEAS）是否是AI中SH的敏感且特异的筛查试验。
总共对185例AI患者进行了肾上腺髓质（血浆甲氧基肾上腺素）和皮质功能亢进[1毫克过夜地塞米松抑制试验（ONDST）、24小时尿游离皮质醇（UFC）、血清DHEAS、血浆肾素和醛固酮]的筛查。ONDST结果阳性[≥1.8 mcg/dL（≥50 nmol/L）]和/或UFC（超过参考范围上限）的患者需进一步检查。当满足以下至少2项时，我们诊断为SH：UFC升高、午夜血清皮质醇升高、48小时地塞米松抑制试验（DST）皮质醇≥1.8 mcg/dL（≥50 nmol/L）。
29例患者（16%）被诊断为SH。所有SH患者的促肾上腺皮质激素均<10 pg/mL（<2.2 pmol/L）。我们计算了所有患者的年龄和性别特异性DHEAS比值（通过将DHEAS除以各自参考范围的下限得出）。受试者工作特征曲线分析表明，比值为1.12对SH的诊断具有敏感性（>99%）和特异性（91.9%）。1毫克ONDST后皮质醇为1.9 mcg/dL（53 nmol/L）是SH的敏感（>99%）筛查试验，但特异性较低（82.9%）。24小时UFC缺乏敏感性（69%）和特异性（72%）。
单次基础测量DHEAS在检测AI患者的SH方面，与现有的金标准1毫克DST相比，具有相当的敏感性和更高的特异性。
