Åkerman Anna-Karin, Sævik Åse Bjorvatn, Thorsby Per Medbøe, Methlie Paal, Quinkler Marcus, Jørgensen Anders Palmstrøm, Höybye Charlotte, Debowska Aleksandra J, Nedrebø Bjørn Gunnar, Dahle Anne Lise, Carlsen Siri, Tomkowicz Aneta, Sollid Stina Therese, Nermoen Ingrid, Grønning Kaja, Dahlqvist Per, Grimnes Guri, Skov Jakob, Finnes Trine, Wahlberg Jeanette, Holte Synnøve Emblem, Simunkova Katerina, Kämpe Olle, Husebye Eystein Sverre, Øksnes Marianne, Bensing Sophie
Department of Medicine, Örebro University Hospital, 701 85 Örebro, Sweden.
Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76 Stockholm, Sweden.
J Clin Med. 2023 May 22;12(10):3602. doi: 10.3390/jcm12103602.
Residual adrenocortical function, RAF, has recently been demonstrated in one-third of patients with autoimmune Addison's disease (AAD). Here, we set out to explore any influence of RAF on the levels of plasma metanephrines and any changes following stimulation with cosyntropin.
We included 50 patients with verified RAF and 20 patients without RAF who served as controls upon cosyntropin stimulation testing. The patients had abstained from glucocorticoid and fludrocortisone replacement > 18 and 24 h, respectively, prior to morning blood sampling. The samples were obtained before and 30 and 60 min after cosyntropin stimulation and analyzed for serum cortisol, plasma metanephrine (MN), and normetanephrine (NMN) by liquid-chromatography tandem-mass pectrometry (LC-MS/MS).
Among the 70 patients with AAD, MN was detectable in 33%, 25%, and 26% at baseline, 30 min, and 60 min after cosyntropin stimulation, respectively. Patients with RAF were more likely to have detectable MN at baseline = 0.035) and at the time of 60 min ( = 0.048) compared to patients without RAF. There was a positive correlation between detectable MN and the level of cortisol at all time points ( = 0.02, = 0.04, < 0.001). No difference was noted for NMN levels, which remained within the normal reference ranges.
Even very small amounts of endogenous cortisol production affect MN levels in patients with AAD.
近期研究表明，三分之一的自身免疫性艾迪生病（AAD）患者存在残余肾上腺皮质功能（RAF）。在此，我们旨在探讨RAF对血浆甲氧基肾上腺素水平的影响以及促肾上腺皮质激素刺激后的变化。
我们纳入了50例经证实存在RAF的患者和20例无RAF的患者，后者作为促肾上腺皮质激素刺激试验的对照。患者在早晨采血前分别停用糖皮质激素和氟氢可的松替代治疗超过18小时和24小时。在促肾上腺皮质激素刺激前、刺激后30分钟和60分钟采集样本，通过液相色谱串联质谱法（LC-MS/MS）分析血清皮质醇、血浆甲氧基肾上腺素（MN）和去甲氧基肾上腺素（NMN）。
在70例AAD患者中，基线时、促肾上腺皮质激素刺激后30分钟和60分钟时，分别有33%、25%和26%的患者可检测到MN。与无RAF的患者相比，有RAF的患者在基线时（P = 0.035）和60分钟时（P = 0.048）更有可能检测到MN。在所有时间点，可检测到的MN与皮质醇水平之间均呈正相关（P = 0.02，P = 0.04，P < 0.001）。NMN水平无差异，均保持在正常参考范围内。
即使是极少量的内源性皮质醇产生也会影响AAD患者的MN水平。
