Department of Medicine DIMED, Endocrinology Unit, University-Hospital of Padova, Padova, Italy.
Department of Medicine DIMED, Laboratory Medicine Unit, University-Hospital of Padova, Padova, Italy.
Endocrine. 2018 Mar;59(3):510-519. doi: 10.1007/s12020-017-1421-3. Epub 2017 Sep 27.
Impaired cortisol rhythm is a characteristic feature of Cushing's Syndrome, nevertheless late night salivary cortisol (LNSC) is not suitable to detect subclinical hypercortisolism in patients with adrenal incidentaloma (AI). We studied daily salivary cortisol (F) and cortisone (E) rhythm in patients with AI.
Six saliva samples were collected from awakening to night in 106 patients with AI and 40 controls. F and E were measured with LC-MS/MS and daily F exposure was calculated with the area under the curve (AUC).
Patients with serum cortisol after dexamethasone suppression test (DST) > 50 nmol/L showed higher morning F (15.5 ± 14.5 vs. 8.6 ± 5.5 nmol/L, p = 0.001), suppressed corticotropin levels (76 vs. 35%, p < 0.001) and increased daily F exposure (3795 ± 1716 vs. 2898 ± 1478, p = 0.012), especially in the morning (2035 ± 1267 vs. 1365 ± 777, p = 0.003), otherwise LNSC levels were similar. Salivary E and AUC levels were higher in patients with DST > 50 nmol/L. AUC was not correlated with urinary cortisol levels or adenoma size. F and E levels were similar among patients with unilateral or bilateral adenoma, or considering the presence of hypertension, dyslipidemia, diabetes, or cardiovascular events.
Daily cortisol exposure, evaluated with AUC from multiple saliva collections, is increased in AI patients with serum cortisol > 50 nmol/L after DST, especially in the morning, leading to reduced corticotropin levels. Cortisol rhythm is preserved in patients with AI, remarking that LNSC is not a screening test for subclinical hypercortisolism.
皮质醇节律紊乱是库欣综合征的特征之一，但唾液皮质醇（LNSC）在检测肾上腺意外瘤（AI）患者亚临床皮质醇增多症时并不适用。本研究旨在探讨 AI 患者的唾液皮质醇（F）和皮质酮（E）昼夜节律。
收集了 106 例 AI 患者和 40 例对照者的 6 份唾液样本，分别于觉醒至夜间进行采集。采用 LC-MS/MS 法检测 F 和 E，计算曲线下面积（AUC）以评估每日 F 暴露量。
地塞米松抑制试验（DST）后血清皮质醇>50nmol/L 的患者，早晨 F 水平更高（15.5±14.5 比 8.6±5.5nmol/L，p=0.001），促肾上腺皮质激素水平受抑制（76%比 35%，p<0.001），且每日 F 暴露量增加（3795±1716 比 2898±1478，p=0.012），尤其是早晨（2035±1267 比 1365±777，p=0.003），但 LNSC 水平相似。DST>50nmol/L 的患者唾液 E 和 AUC 水平较高。AUC 与尿皮质醇水平或腺瘤大小无关。单侧或双侧腺瘤患者，或考虑存在高血压、血脂异常、糖尿病或心血管事件的患者，其 F 和 E 水平相似。
DST 后血清皮质醇>50nmol/L 的 AI 患者，每日皮质醇暴露量（通过多次唾液采集的 AUC 评估）增加，尤其是早晨，导致促肾上腺皮质激素水平降低。AI 患者皮质醇节律正常，这表明 LNSC 不是亚临床皮质醇增多症的筛查试验。
