Department of Endocrinology, Skane University Hospital, Lund, Sweden.
Department of Clinical Sciences in Lund, Lund University, Lund, Sweden.
Clin Endocrinol (Oxf). 2021 Feb;94(2):168-175. doi: 10.1111/cen.14357. Epub 2020 Nov 15.
During the investigation of adrenal incidentalomas, it is important to accurately diagnose autonomous cortisol secretion (ACS) but the specificity of cortisol ≥50 nmol/L after overnight dexamethasone suppression (cortisol ) is low. Therefore, ACTH following overnight dexamethasone suppression (ACTH ) and cortisol following a 2-day dexamethasone suppression test (cortisol ) were examined as markers of HPA axis suppression during ONDST.
This cross-sectional study examined patients with adrenal incidentalomas and basal ACTH ≥ 2.0 pmol/L who underwent ONDST.
ACTH /ACTH ratio (ACTH ratio) was calculated for all patients. To define cut-off levels for ACTH and ACTH ratio as markers of HPA axis suppression, ROC curves were used to separate patients with cortisol <50 and ≥50 nmol/L.
Cortisol was ≥50 nmol/L in 140 out of 373 patients. In patients with cortisol <50 nmol/L, ACTH was 0.28 pmol/L (<0.23-2.7). DHEAS was positively correlated to ACTH , demonstrating a 9% increase with a doubling in ACTH , p = 0.02. The best cut-off levels for ACTH and ACTH ratio to detect cortisol ≥50 nmol/L were ≥0.6 pmol/L and ≥18% respectively. These cut-off levels were tested on patients with cortisol <50 nmol/L, considered to have adequate suppression (n = 233), and patients with reduction of ≥50 nmol/L from cortisol to cortisol , who were considered to have inadequate suppression (n = 16). ACTH ≥0.6 pmol/L and ACTH ratio ≥18% had a sensitivity of 75% and 81% respectively, and a specificity of 78% and 85% respectively, for detecting patients with inadequate suppression.
ACTH and ACTH ratio can be markers of HPA axis suppression in the investigation of adrenal incidentalomas. Cortisol ≥50 nmol/L with ACTH <0.6 pmol/L or ACTH ratio <18% should lead to the suspicion of ACS.
在对肾上腺意外瘤进行研究时，准确诊断自主皮质醇分泌（ACS）非常重要，但过夜地塞米松抑制试验后皮质醇≥50nmol/L 的特异性较低。因此，本研究在去氨加压素刺激试验（ONDST）中检查了过夜地塞米松抑制试验后 ACTH（ACTH ）和 2 天地塞米松抑制试验后皮质醇（皮质醇）作为 HPA 轴抑制的标志物。
本横断面研究检查了基础 ACTH≥2.0pmol/L 并接受了 ONDST 的肾上腺意外瘤患者。
对所有患者计算了 ACTH/ACTH 比值（ACTH 比值）。为了定义 ACTH 和 ACTH 比值作为 HPA 轴抑制标志物的截断值，使用 ROC 曲线将皮质醇<50nmol/L 和≥50nmol/L 的患者分开。
373 例患者中有 140 例皮质醇≥50nmol/L。在皮质醇<50nmol/L 的患者中，ACTH 为 0.28pmol/L（0.23-2.7）。DHEAS 与 ACTH 呈正相关，ACTH 加倍时增加 9%，p=0.02。ACTH 和 ACTH 比值的最佳截断值以检测皮质醇≥50nmol/L 分别为≥0.6pmol/L 和≥18%。这些截断值在皮质醇<50nmol/L 的患者（认为是充分抑制的患者，n=233）和皮质醇从皮质醇降低≥50nmol/L 的患者（认为是抑制不足的患者，n=16）中进行了测试。ACTH≥0.6pmol/L 和 ACTH 比值≥18%的敏感性分别为 75%和 81%，特异性分别为 78%和 85%，用于检测抑制不足的患者。
ACTH 和 ACTH 比值可作为肾上腺意外瘤研究中 HPA 轴抑制的标志物。皮质醇≥50nmol/L 伴 ACTH<0.6pmol/L 或 ACTH 比值<18%时，应怀疑 ACS。
