Neuroendocrinology Unit, Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain.
Universidad de Alcalá, Madrid, Spain.
Sci Rep. 2021 Oct 15;11(1):20539. doi: 10.1038/s41598-021-00011-4.
To evaluate the diagnostic accuracy of the different tests commonly used in the evaluation of adrenal incidentalomas (AIs) for the identification of autonomous cortisol secretion (ACS) and comorbidities potentially related to ACS. In a retrospective study of patients with AIs ≥ 1 cm, we evaluated the diagnostic reliability and validity of the dexamethasone suppression test (DST), urinary free cortisol (UFC), ACTH, late-night salivary cortisol (LNSC), and dehydroepiandrosterone-sulphate (DHEAS) for the diagnosis of comorbidities potentially related to ACS. Diagnostic indexes were also calculated for UFC, ACTH, LNSC, and DHEAS considering DST as the gold standard test for the diagnosis of ACS, using three different post-DST cortisol thresholds (138 nmol/L, 50 nmol/L and 83 nmol/L). We included 197 patients with AIs in whom the results of the five tests abovementioned were available. At diagnosis, 85.9% of patients with one or more AIs had any comorbidity potentially related to ACS, whereas 9.6% had ACS as defined by post-DST cortisol > 138 nmol/L. The reliability of UFC, ACTH, LNSC, and DHEAS for the diagnosis of ACS was low (kappa index < 0.30). Of them, LNSC reached the highest diagnosis accuracy for ACS identification (AUC = 0.696 [95% CI 0.626-0.759]). The diagnostic performances of these tests for comorbidities potentially related to ACS was poor; of them, the DST was the most accurate (AUC = 0.661 [95% CI 0.546-0.778]) and had the strongest association with these comorbidities (OR 2.6, P = 0.045). Patients presenting with increased values of both DST and LNSC had the strongest association with hypertension (OR 7.1, P = 0.002) and with cardiovascular events (OR 3.6, P = 0.041). In conclusion, LNSC was the test showing the highest diagnosis accuracy for the identification of ACS when a positive DST was used as the gold standard for its diagnosis. The DST test showed the strongest association with comorbidities potentially related to ACS. The definition of ACS based on the combination of elevated DST and LNSC levels improved the identification of patients with increased cardiometabolic risk.
评估用于评估肾上腺偶发瘤（AIs）的不同检测方法的诊断准确性，以识别自主皮质醇分泌（ACS）和可能与 ACS 相关的合并症。在一项对 AIs≥1cm 的患者的回顾性研究中，我们评估了地塞米松抑制试验（DST）、尿游离皮质醇（UFC）、ACTH、夜间唾液皮质醇（LNSC）和硫酸脱氢表雄酮（DHEAS）在诊断可能与 ACS 相关的合并症方面的诊断可靠性和有效性。还计算了 UFC、ACTH、LNSC 和 DHEAS 的诊断指数，考虑到 DST 是 ACS 诊断的金标准测试，使用了三个不同的 post-DST 皮质醇阈值（138nmol/L、50nmol/L 和 83nmol/L）。我们纳入了 197 名具有上述五项检测结果的 AIs 患者。在诊断时，85.9%的 AIs 患者存在一种或多种可能与 ACS 相关的合并症，而 9.6%的患者存在 post-DST 皮质醇>138nmol/L 定义的 ACS。UFC、ACTH、LNSC 和 DHEAS 用于诊断 ACS 的可靠性较低（kappa 指数<0.30）。其中，LNSC 对 ACS 诊断的准确性最高（AUC=0.696[95%CI 0.626-0.759]）。这些检测方法用于诊断可能与 ACS 相关的合并症的诊断性能较差；其中，DST 最准确（AUC=0.661[95%CI 0.546-0.778]），与这些合并症的关联最强（OR 2.6，P=0.045）。同时出现 DST 和 LNSC 升高的患者与高血压（OR 7.1，P=0.002）和心血管事件（OR 3.6，P=0.041）的关联最强。总之，当 DST 阳性作为 ACS 诊断的金标准时，LNSC 是用于诊断 ACS 的诊断准确性最高的检测方法。DST 检测与可能与 ACS 相关的合并症的关联最强。基于升高的 DST 和 LNSC 水平的 ACS 定义提高了识别心血管代谢风险增加的患者的能力。
