标准剂量促皮质素兴奋试验期间的皮质醇值：Elecsys 皮质醇 II 检测的个人经验。
Cortisol values during the standard-dose cosyntropin stimulation test: Personal experience with Elecsys cortisol II assay.
机构信息
Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
出版信息
Front Endocrinol (Lausanne). 2022 Aug 18;13:978238. doi: 10.3389/fendo.2022.978238. eCollection 2022.
PURPOSE
There has been debate regarding the appropriate cortisol cutoff during the cosyntropin stimulation test (CST) when newer cortisol assays are used. We aimed to evaluate the proper cortisol values during the standard dose CST in patients with normal hypothalamic-pituitary-adrenal (HPA) axis when the Elecsys Cortisol II assay from Roche Diagnostics is used.
METHODS
We retrospectively reviewed the medical records of patients evaluated for possible adrenal insufficiency using the standard-dose (250 mcg) CST from January 2018 to December 2020 and eventually judged to have a normal HPA axis. All the CSTs were done in the outpatient setting. Evaluation by an endocrinologist, restrictive exclusion criteria including prior glucocorticoid and opioid use, and lack of glucocorticoid treatment for at least 6 months after the CST was used to define normal HPA axis. The results are reported in the median (range).
RESULTS
We identified 63 patients who met the inclusion criteria and were considered to have a normal HPA axis. The median age was 54.7 (27.6-89.1) years; 32 (51%) were female, and 27 (43%) were white. The duration of follow-up after the CST without any glucocorticoid replacement was 13.9 (6.3-43.9) months. Cortisol levels were 21.7 (15.7-29.1) µg/dl and 24.4 (17.9-35.8) µg/dl at 30- and 60-minutes after cosyntropin administration, respectively. The lowest cortisol levels at 30 and 60 minutes for patients with either normal TSH or gonadal axis (n=47) or in whom both axes were normal (n=18) were similar to the ones of the entire cohort.
CONCLUSION
Our study supports using a lower than previously recommended cortisol cutoff value at 30 minutes after Cosyntropin using the Roche Elecsys Cortisol II assay. The lowest cortisol levels in our cohort were 15.7 and 17.9 µg/dL at 30 and 60 minutes after the CST, respectively. Therefore, it is essential to consider the time of cortisol draw after cosyntropin administration.
目的
当使用新的皮质醇检测方法时，关于在促皮质素刺激试验（CST）期间使用哪种适当的皮质醇切点一直存在争议。我们旨在评估使用罗氏诊断 Elecsys 皮质醇 II 检测时，在下丘脑-垂体-肾上腺（HPA）轴正常的患者中进行标准剂量 CST 时的适当皮质醇值。
方法
我们回顾性分析了 2018 年 1 月至 2020 年 12 月期间使用标准剂量（250µg）CST 评估疑似肾上腺功能不全的患者的病历，最终判断 HPA 轴正常。所有 CST 均在门诊进行。由内分泌科医生评估，限制排除标准包括之前使用糖皮质激素和阿片类药物，以及 CST 后至少 6 个月未接受糖皮质激素治疗，以此来定义 HPA 轴正常。结果以中位数（范围）报告。
结果
我们确定了 63 名符合纳入标准并被认为 HPA 轴正常的患者。中位年龄为 54.7（27.6-89.1）岁；32 名（51%）为女性，27 名（43%）为白人。CST 后不使用任何糖皮质激素替代的随访时间为 13.9（6.3-43.9）个月。皮质醇水平在 30 分钟和 60 分钟时分别为 21.7（15.7-29.1）µg/dl 和 24.4（17.9-35.8）µg/dl。在促皮质素给药后 30 分钟和 60 分钟时，TSH 或性腺轴正常的患者（n=47）或两个轴均正常的患者（n=18）的最低皮质醇水平与整个队列相似。
结论
我们的研究支持使用罗氏 Elecsys 皮质醇 II 检测，在促皮质素给药后 30 分钟时使用低于之前推荐的皮质醇切点值。我们队列中的最低皮质醇水平分别为 CST 后 30 分钟和 60 分钟时的 15.7µg/dL 和 17.9µg/dL。因此，考虑促皮质素给药后皮质醇抽取的时间至关重要。
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