Department of Nuclear Medicine, University Hospital of Bordeaux, Bordeaux, France.
Nutrition et Neurobiologie Intégrée, University of Bordeaux, Bordeaux, France.
Eur J Endocrinol. 2021 Mar;184(3):445-454. doi: 10.1530/EJE-20-1127.
Hair cortisol (HF) and cortisone (HE) measurements reflect tissular exposure to cortisol over months and are increased in overt Cushing's syndrome (CS). No data is available in mild CS. We compared the diagnostic performance of HF and HE between patients with overt or mild CS.
Single centre retrospective study.
HF&HE were measured by LC-MS/MS in 48 consecutive adult females with Cushing's disease (CD), ectopic ACTH syndrome, secreting adenomas and carcinomas, and adrenal incidentalomas. All had impaired dexamethasone suppression tests. Overt CS (n = 25) was diagnosed in front of specific symptoms, a mean UFC (>1.5 ULN) and increased midnight serum cortisol or salivary cortisol. Mild CS (n = 23) was diagnosed in patients lacking specific symptoms and displaying at least one additional biological abnormality including mildly increased UFC (≤1.5 ULN), increased midnight serum cortisol or salivary cortisol and suppressed plasma ACTH in patients with adrenal tumours. In this study, 84 healthy subjects and obese patients served as controls.
HF and HE showed roughly similar performance in overt CS (92 and 100% sensitivity, 91 and 99% specificity, respectively). HF and HE were lower in mild CS but higher than in controls (P < 0.01). HE was correlated with midnight serum cortisol (P < 0.02) and volume of adrenal incidentalomas (P < 0.04) but not with UFC. HF and HE had 59% and 68% sensitivity, and 79 and 94% specificity, respectively, for the diagnosis of mild CS. Contrary to UFC, both HF and HE were in the range of overt CS in 11/23 patients with mild CS. Patients with mild CS and increased HE required more antihypertensive treatments and showed worser lipid profiles than patients with normal HE.
HF and HE measurement performed better in overt than in mild CS but is a useful adjunct to diagnose mild CS and to identify adrenocortical incidentalomas responsible for excessive cortisol exposure.
毛发皮质醇（HF）和皮质酮（HE）的测量反映了皮质醇在数月内对组织的暴露情况，在明显库欣综合征（CS）中会增加。在轻度 CS 中尚无数据。我们比较了显性和轻度 CS 患者 HF 和 HE 的诊断性能。
单中心回顾性研究。
对 48 例连续成年女性的库欣病（CD）、异位 ACTH 综合征、分泌腺瘤和癌、肾上腺意外瘤患者的 HF&HE 进行 LC-MS/MS 测量。所有患者的地塞米松抑制试验均受损。显性 CS（n = 25）在出现特定症状、平均 UFC（>1.5ULN）和午夜血清皮质醇或唾液皮质醇升高之前诊断。轻度 CS（n = 23）在缺乏特定症状且至少存在一种其他生物学异常的患者中诊断，包括 UFC 轻度升高（≤1.5ULN）、午夜血清皮质醇或唾液皮质醇升高和肾上腺肿瘤患者的血浆 ACTH 抑制。在这项研究中，84 名健康受试者和肥胖患者作为对照。
HF 和 HE 在显性 CS 中表现出大致相似的性能（分别为 92%和 100%的敏感性，91%和 99%的特异性）。HF 和 HE 在轻度 CS 中较低，但高于对照组（P < 0.01）。HE 与午夜血清皮质醇（P < 0.02）和肾上腺意外瘤体积（P < 0.04）相关，但与 UFC 无关。HF 和 HE 对轻度 CS 的诊断分别有 59%和 68%的敏感性和 79%和 94%的特异性。与 UFC 相反，11/23 例轻度 CS 患者的 HF 和 HE 均处于显性 CS 范围内。HE 升高的轻度 CS 患者需要更多的降压治疗，并且血脂谱比 HE 正常的患者更差。
HF 和 HE 的测量在显性 CS 中比在轻度 CS 中表现更好，但它是诊断轻度 CS 和识别导致皮质醇过度暴露的肾上腺意外瘤的有用辅助手段。
