Huayllas Martha K P, Netzel Brian C, Singh Ravinder J, Kater Claudio E
Steroids Laboratory, Adrenal and Hypertension Unit, Division of Endocrinology and Metabolism, Department of Medicine, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP).
Department of Neuroendocrinology, Hospital Brigadeiro, São Paulo, Brazil.
Lab Med. 2018 Jul 5;49(3):259-267. doi: 10.1093/labmed/lmy005.
Adrenal incidentalomas (AIs) are present in 4% of adults. As many as 30% may secrete cortisol autonomously in the absence of specific signs of overt hypercortisolism, in a phenomenon called subclinical hypercortisolism (SH). Diagnosis of SH is established by serum cortisol resistance to dexamethasone suppression.
We compared serum cortisol concentrations, as determined by radioimmunoassay (RIA) and liquid chromatography/tandem mass spectronomy (LC/MS-MS), in 73 patients with AI group (52 with unilateral AI) and 34 control subjects in 3 scenarios: basal; after 1-mg dexamethasone suppression; and after 0.25-mg stimulation with cosyntropin, a synthetic derivative of adrenocorticotropic hormone (ACTH). To bolster evidence for the diagnosis of SH, we also measured salivary cortisol levels at 11 PM and after DST, as well as plasma ACTH and serum dehydroepiandrosterone sulfate (DHEA-S) levels.
We observed significant positive correlation (r = 0.9345, P <.001) for all 318 pairs of serum cortisol values, as measured by both methods.
Serum cortisol concentrations in patients with AI and in control subjects were very similar, as measured by RIA and LC/MS-MS.
肾上腺偶发瘤（AIs）在4%的成年人中存在。多达30%的肾上腺偶发瘤患者可能在无明显皮质醇增多症特定体征的情况下自主分泌皮质醇，这种现象称为亚临床皮质醇增多症（SH）。SH的诊断通过血清皮质醇对地塞米松抑制的抵抗来确立。
我们比较了73例肾上腺偶发瘤患者组（52例单侧肾上腺偶发瘤）和34例对照受试者在3种情况下通过放射免疫分析（RIA）和液相色谱/串联质谱法（LC/MS-MS）测定的血清皮质醇浓度：基础状态；1毫克地塞米松抑制后；以及用促肾上腺皮质激素（ACTH）的合成衍生物促肾上腺皮质激素释放激素（cosyntropin）0.25毫克刺激后。为了加强SH诊断的证据，我们还测量了晚上11点和地塞米松抑制试验（DST）后的唾液皮质醇水平，以及血浆促肾上腺皮质激素（ACTH）和血清硫酸脱氢表雄酮（DHEA-S）水平。
通过两种方法测量的所有318对血清皮质醇值均观察到显著正相关（r = 0.9345，P <.001）。
通过放射免疫分析（RIA）和液相色谱/串联质谱法（LC/MS-MS）测量，肾上腺偶发瘤患者和对照受试者的血清皮质醇浓度非常相似。
