Li Lele, Yang Guoqing, Dou Jingtao, Gu Weijun, Lv Zhaohui, Lu Juming, Mu Yiming
Department of Endocrinology, Chinese PLA General Hospital, Beijing, China.
Chinese PLA Key Laboratory of Endocrinology and Metabolism, Beijing, China.
Exp Clin Endocrinol Diabetes. 2018 Feb;126(2):71-76. doi: 10.1055/s-0043-101236. Epub 2017 Sep 20.
The cortisol/ACTH ratio was supposed to be helpful in the screening of subclinical hypercortisolism (SHC) in the published literatures. This study assessed the cortisol/ACTH ratio in patients with adrenal incidentaloma (AI) confirmed to have SHC and investigated its role for screening SCS in patients with AI.
This descriptive retrospective study included 183 patients with AIs [45 with SHC and 138 with non-functional adenoma (NFA)]. Cortisol and ACTH levels were measured at 8:00, 16:00, and 0:00, and the cortisol/ACTH ratio was calculated. ROC curve was used to evaluate efficacy of the cortisol/ACTH ratio, explore the best cut-off value and its corresponding sensitivity and specificity.
The cortisol/ACTH ratios at all time points were significantly higher in the SHC group than the NFA group (P<0.05) and were significantly correlated with serum cortisol levels after the 1-mg dexamethasone suppression test (DST). Area Under the Curve (AUC) of the cortisol/ACTH ratio at 0:00 and midnight serum cortisol levels were 0.893 (0.843-0.943) and 0.831 (0.765-0.806), respectively. A cortisol/ACTH ratio at 0:00 cut-off of 32.18 nM/pM showed a sensitivity of 100% and specificity of 39.1%. The optimal cut-off was 68.83 nM/pM (sensitivity 86.7%, specificity 75.4%).
Patients with SHC have a higher cortisol/ACTH ratio than those with NFAs. The cortisol/ACTH ratio is significantly correlated with serum cortisol after the 1-mg DST. The diagnostic performance of the cortisol/ACTH ratio at 0:00 is superior to midnight serum cortisol. Therefore, the cortisol/ACTH ratio at 0:00 may be a reliable parameter for SHC screening in patient with AI.
在已发表的文献中，皮质醇/促肾上腺皮质激素（ACTH）比值被认为有助于亚临床皮质醇增多症（SHC）的筛查。本研究评估了确诊为SHC的肾上腺意外瘤（AI）患者的皮质醇/ACTH比值，并探讨了其在AI患者中筛查SHC的作用。
这项描述性回顾性研究纳入了183例AI患者[45例SHC患者和138例无功能腺瘤（NFA）患者]。在8:00、16:00和0:00测量皮质醇和ACTH水平，并计算皮质醇/ACTH比值。采用ROC曲线评估皮质醇/ACTH比值的效能，探索最佳截断值及其相应的敏感性和特异性。
SHC组所有时间点的皮质醇/ACTH比值均显著高于NFA组（P<0.05），且与1毫克地塞米松抑制试验（DST）后的血清皮质醇水平显著相关。0:00时皮质醇/ACTH比值的曲线下面积（AUC）和午夜血清皮质醇水平分别为0.893（0.843-0.943）和0.831（0.765-0.806）。0:00时皮质醇/ACTH比值截断值为32.18 nM/pM时，敏感性为100%，特异性为39.1%。最佳截断值为68.83 nM/pM（敏感性86.7%，特异性75.4%）。
SHC患者的皮质醇/ACTH比值高于NFA患者。皮质醇/ACTH比值与1毫克DST后的血清皮质醇显著相关。0:00时皮质醇/ACTH比值的诊断性能优于午夜血清皮质醇。因此，0:00时的皮质醇/ACTH比值可能是AI患者筛查SHC的可靠参数。
