Rao X J, Jiang D Y, Zang L, Guo Q H, Lyu Z H, Mu Y M
Department of Endocrinology, the First Medical Center, PLA General Hospital, Beijing 100853, China Department of Endocrinology, the Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450045, China.
Department of Endocrinology, the First Medical Center, PLA General Hospital, Beijing 100853, China.
Zhonghua Yi Xue Za Zhi. 2024 Aug 6;104(30):2830-2836. doi: 10.3760/cma.j.cn112137-20240201-00248.
To investigate the value of serum dehydroepiandrosterone sulfate (DHEAS) in the differential diagnosis of primary bilateral macronodular adrenal hyperplasia (PBMAH) from nonfunctional adenoma tumors (NFA), adrenocortical adenoma (ADA) and Cushing's disease (CD). A cross-sectional study. The clinical data of 302 patients with PBMAH, NFA, ADA and CD diagnosed and treated in the First Medical Center of PLA General Hospital from January 2010 to June 2021 were retrospectively analyzed. Among them, 97 were males and 205 were females, aged (45.7±7.2) years. The area under receiver operating characteristic (ROC) curve was used to evaluate the DHEAS ratio (serum DHEAS value divided by the lower limit of normal reference range for the corresponding age and sex) and the 8∶00 adrenocorticotropic hormone (ACTH) level in the differential diagnosis of PBMAH from NFA, ADA and CD. The maximum value of Youden index was cut-off value. Among the 302 patients, 33 were in PBMAH group, 125 were in NFA group, 67 were in ADA group, and 77 were in CD group. The DHEAS ratio in CD group, NFA group, PBMAH group and ADA group decreased successively, with values of 6.34(4.44, 9.93), 3.37(2.24, 4.79), 1.14(1.04, 2.40) and 0.58(0.27, 1.05), respectively. There was statistical significance among all groups (all <0.01). The area under the ROC curve for distinguishing PBMAH from NFA, ADA and CD were 0.803, 0.741 and 0.930, and the cut-off value were 2.59, 0.99 and 2.92, respectively. The sensitivity was 66.1%, 64.2% and 87.9%, respectively. The specificity was 81.8%, 81.2% and 85.7%. According to the level of 8∶00 ACTH, PBMAH was divided into ACTH-inhibited group (ACTH<2.2 pmol/L,=18) and ACTH-non-inhibited group (ACTH≥2.2 pmol/L, =15).The DHEAS ratio in ACTH-non-inhibited PBMAH group was higher than that in ACTH-inhibited PBMAH group(<0.01).The area under ROC curve of DHEAS ratio for identifying ACTH-non-inhibited PBMAH and CD was 0.877, the cut-off value was 4.55, the sensitivity was 93.3%, and the specificity was 75.3%. If the DHEAS ratio combined with 8∶00 ACTH was used as a differential diagnostic indicator, the area under the ROC curve for distinguishing ACTH-non-inhibitory PBMAH from CD can reach 0.967, with the sensitivity of 100.0% and the specificity of 81.8%. DHEAS ratios is different in PBMAH, NFA, ADA and CD patients, which can assist in the differential diagnosis of PBMAH from NFA、ADA and CD patients, especially in the differential diagnosis of ACTH-non-inhibited PBMAH patients and CD patients.
探讨血清硫酸脱氢表雄酮（DHEAS）在原发性双侧大结节性肾上腺增生（PBMAH）与无功能腺瘤（NFA）、肾上腺皮质腺瘤（ADA）及库欣病（CD）鉴别诊断中的价值。一项横断面研究。回顾性分析2010年1月至2021年6月在解放军总医院第一医学中心诊断并治疗的302例PBMAH、NFA、ADA及CD患者的临床资料。其中男性97例，女性205例，年龄（45.7±7.2）岁。采用受试者操作特征（ROC）曲线下面积评估DHEAS比值（血清DHEAS值除以相应年龄和性别的正常参考范围下限）及8∶00促肾上腺皮质激素（ACTH）水平在PBMAH与NFA、ADA及CD鉴别诊断中的价值。以约登指数最大值为截断值。302例患者中，PBMAH组33例，NFA组125例，ADA组67例，CD组77例。CD组、NFA组、PBMAH组及ADA组的DHEAS比值依次降低，分别为6.34（4.44，9.93）、3.37（2.24，4.79）、1.14（1.04，2.40）及0.58（0.27，1.05）。各组间差异有统计学意义（均<0.01）。区分PBMAH与NFA、ADA及CD的ROC曲线下面积分别为0.803、0.741及0.930，截断值分别为2.59、0.99及2.92，敏感性分别为66.1%、64.2%及87.9%，特异性分别为81.8%、81.2%及85.7%。根据8∶00 ACTH水平，将PBMAH分为ACTH抑制组（ACTH<2.2 pmol/L，n = 18）和ACTH非抑制组（ACTH≥2.2 pmol/L，n = 15）。ACTH非抑制性PBMAH组的DHEAS比值高于ACTH抑制性PBMAH组（<0.01）。DHEAS比值鉴别ACTH非抑制性PBMAH与CD的ROC曲线下面积为0.877，截断值为4.55，敏感性为93.3%，特异性为75.3%。若将DHEAS比值与8∶00 ACTH联合作为鉴别诊断指标，区分ACTH非抑制性PBMAH与CD的ROC曲线下面积可达0.967，敏感性为100.0%，特异性为81.8%。PBMAH、NFA、ADA及CD患者的DHEAS比值不同，可辅助PBMAH与NFA、ADA及CD患者的鉴别诊断，尤其在ACTH非抑制性PBMAH患者与CD患者的鉴别诊断中。
