Department of Internal Medicine D, Sheba Medical Center, Tel-Hashomer, Israel; Tel-Aviv University, Sackler Faculty of Medicine, Tel-Aviv, Israel.
Department of Internal Medicine D, Sheba Medical Center, Tel-Hashomer, Israel; Tel-Aviv University, Sackler Faculty of Medicine, Tel-Aviv, Israel; The Institute of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel-Hashomer, Israel.
Endocr Pract. 2020 Sep;26(9):974-982. doi: 10.4158/EP-2020-0111.
Autonomous cortisol secretion (ACS) is the most common endocrine abnormality in the evaluation of adrenal incidentalomas. The categorization of ACS is derived from a 1 mg dexamethasone suppression test (DST). Impaired DST is associated with several metabolic derangements. In this study we analyzed the association between post-DST cortisol level, analyzed as a continuous parameter, and indices of glycemic metabolism.
We prospectively collected data of 1,976 patients evaluated for adrenal incidentalomas in a large tertiary medical center between December 1, 2017, and August 31, 2019. Seventy-three patients completed the evaluation process. Post-DST cortisol levels were analyzed for correlation with various metabolic parameters, including fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) among the general cohort and for subgroups stratified by the number of metabolic syndrome (MS) criteria.
Post-DST cortisol demonstrated a linear association with FPG and HbA1c across its entire cortisol range (R = 0.51 and 0.41, respectively; P≤.01). The association between post-DST cortisol and FPG was strengthened with an increased number of metabolic syndrome criteria. Patients with 4 MS criteria show a stronger association (R = 0.92) compared to patients with only a single criterion (R = 0.509). Furthermore, mean post-DST cortisol levels increased as the number of MS criteria accumulated.
Post-DST cortisol should be viewed as a continuous parameter in risk stratification algorithms for the development of MS and particularly dysglycemia.
自主皮质醇分泌（ACS）是评估肾上腺意外瘤时最常见的内分泌异常。ACS 的分类源自 1mg 地塞米松抑制试验（DST）。DST 受损与多种代谢紊乱有关。在这项研究中，我们分析了 DST 后皮质醇水平（作为连续参数）与血糖代谢指标之间的关系。
我们前瞻性地收集了 2017 年 12 月 1 日至 2019 年 8 月 31 日期间在一家大型三级医学中心评估肾上腺意外瘤的 1976 名患者的数据。73 名患者完成了评估过程。分析 DST 后皮质醇水平与各种代谢参数的相关性，包括一般队列中的空腹血糖（FPG）和糖化血红蛋白（HbA1c），以及按代谢综合征（MS）标准数量分层的亚组。
DST 后皮质醇与 FPG 和 HbA1c 呈线性相关，皮质醇范围广泛（分别为 R=0.51 和 0.41；P≤0.01）。随着 MS 标准数量的增加，DST 后皮质醇与 FPG 的相关性增强。与只有一个标准的患者相比（R=0.509），有 4 个 MS 标准的患者表现出更强的相关性（R=0.92）。此外，随着 MS 标准的积累，平均 DST 后皮质醇水平升高。
DST 后皮质醇应作为 MS 特别是血糖异常发展的风险分层算法中的一个连续参数来看待。
