Liu Meng-Si, Lou Yuan, Chen Huan, Wang Yi-Jie, Zhang Zi-Wei, Li Ping, Zhu Da-Long
Department of Endocrinology, Drum Tower Hospital Affiliated to Nanjing University Medical School, Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, People's Republic of China.
Department of Endocrinology, Nanjing Drum Tower Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, People's Republic of China.
J Clin Endocrinol Metab. 2022 Apr 19;107(5):e1789-e1796. doi: 10.1210/clinem/dgac072.
Autonomous cortisol secretion (ACS) affects up to 30% of patients with adrenal incidentalomas (AIs). The current guidelines for ACS diagnosis are not decisive. A lower dehydroepiandrosterone sulfate (DHEAS) level is a potential biomarker, but the evidence is conflicting.
This prospective study aimed to evaluate and validate the ACS screening and diagnostic accuracy of DHEAS.
Recruited patients with AI were screened for adrenal medullary and cortisol hypersecretion. The diagnosis of ACS was based on a serum cortisol level ≥ 50 nmol/L following a 1-mg dexamethasone suppression test (DST) and a low-dose DST. Age- and sex-specific DHEAS ratios were also calculated.
In the development cohort (45 ACS and 242 non-ACS patients), the areas under the receiver operator characteristic curves (AUCs) of DHEAS and the DHEAS ratio were 0.869 (95% CI 0.824-0.906) and 0.799 (95% CI 0.748-0.844), respectively. The optimal DHEAS cutoff for diagnosing ACS was 60 μg/dL, with a sensitivity of 75.6% (95% CI 60.5-87.1) and a specificity of 81.4% (95% CI 76.4-86.5). The midnight serum cortisol level had moderate diagnostic accuracy [AUC 0.875 (95% CI 0.831-0.911)]. Suppressed adrenocorticotropic hormone (≤2.2 pmol/L) had a lower sensitivity (55.6%), and the 24-hour urinary free cortisol lacked sensitivity and specificity [AUC 0.633 (95% CI 0.603-0.721)]. In the validation cohort (14 ACS and 45 non-ACS patients), the sensitivity and specificity of the optimized DHEAS cutoff were 71.4% (95% CI 41.9-91.6) and 82.2% (95% CI 68.0-92.0), respectively.
A single basal measurement of DHEAS is valuable for identifying ACS. Because of its stability and ease of use, the DHEAS level could be used as an ACS screening test.
自主性皮质醇分泌（ACS）影响高达30%的肾上腺偶发瘤（AI）患者。目前ACS诊断指南并不具有决定性。硫酸脱氢表雄酮（DHEAS）水平降低是一种潜在的生物标志物，但证据存在矛盾。
这项前瞻性研究旨在评估和验证DHEAS对ACS的筛查及诊断准确性。
招募的AI患者接受肾上腺髓质和皮质醇分泌过多的筛查。ACS的诊断基于1毫克地塞米松抑制试验（DST）和低剂量DST后血清皮质醇水平≥50 nmol/L。还计算了年龄和性别特异性DHEAS比值。
在开发队列（45例ACS患者和242例非ACS患者）中，DHEAS和DHEAS比值的受试者操作特征曲线下面积（AUC）分别为0.869（95%CI 0.824 - 0.906）和0.799（95%CI 0.748 - 0.844）。诊断ACS的最佳DHEAS临界值为60 μg/dL，敏感性为75.6%（95%CI 60.5 - 87.1），特异性为81.4%（95%CI 76.4 - 86.5）。午夜血清皮质醇水平具有中等诊断准确性[AUC 0.875（95%CI 0.831 - 0.911）]。促肾上腺皮质激素抑制（≤2.2 pmol/L）敏感性较低（55.6%），24小时尿游离皮质醇缺乏敏感性和特异性[AUC 0.633（95%CI 0.603 - 0.721）]。在验证队列（14例ACS患者和45例非ACS患者）中，优化后的DHEAS临界值的敏感性和特异性分别为71.4%（95%CI 41.9 - 91.6）和82.2%（95%CI 68.0 - 92.0）。
单次基础测量DHEAS对识别ACS有价值。由于其稳定性和易用性，DHEAS水平可作为ACS筛查试验。
