Rao X J, Jiang D Y, Guo Q H, Zang L, Lyu Z H, Mu Y M
Department of Endocrinology, the First Medical Center of Chinese PLA General Hospital, Beijing 100853, China.
Zhonghua Nei Ke Za Zhi. 2024 Sep 1;63(9):849-854. doi: 10.3760/cma.j.cn112138-20240201-00092.
To evaluate the function of serum dehydroepiandrosterone sulfate (DHEAS) in adult adrenal space-occupying lesions. In this cross-sectional study, 395 patients with adrenal space-occupying lesions who had their DHEAS levels measured were collected from the First Medical Center of Chinese PLA General Hospital from January 2010 to June 2021. They were divided into the adrenal Cushing syndrome (ACS) group (=100) and non-ACS group (=295). The former was divided into the cortisol-producing adrenal adenoma (CPA) group (=67) and primary bilateral macronodular adrenal hyperplasia (PBMAH) group (=33). Clinical data of each group were collected and compared among groups by independent samples -test, chi-square test, and Mann-Whitney test. Serum DHEAS ratio corrected for age and sex was further constructed to identify the receiver operating characteristic curve and the optimal tangent point value for different adrenal occupation. Patients in the ACS group were younger (44.9±13.7 vs. 49.9±12.5, =0.001); had a larger proportion of women (79/100 vs.139/295, =0.001); and had higher cortisol levels [8∶00Am, 497.31 (343.52, 606.50) vs. 353.11 (267.50, 487.91) nmol/L, <0.001] than those in the non-ACS group. The serum DHEAS level and ratio in the ACS group were significantly lower than those in the non-ACS group [0.50 (0.40, 1.21) vs. 2.68 (1.56, 4.32) μmol/L, 1.00 (0.43, 1.68) vs. 3.17 (2.21, 4.54), both <0.001]. When the serum DHEAS ratio cut-off point was 1.29, the sensitivity and specificity for differential diagnosis of ACS and non-ACS were 72.0% and 91.5% respectively. The ratio of DHEAS in the CPA group was lower [0.58 (0.27, 1.05) vs. 1.14 (1.04, 2.40), 0.001] than that in the PBMAH group. When the serum DHEAS ratio cut-off point was 0.99, the sensitivity and specificity for differential diagnosis of CPA and PBMAH were 64.2% and 81.2% respectively. Corrected age-sex DHEAS ratio can assist in the functional assessment of adrenal space-occupying lesions.
评估血清硫酸脱氢表雄酮（DHEAS）在成人肾上腺占位性病变中的作用。在这项横断面研究中，收集了2010年1月至2021年6月在中国人民解放军总医院第一医学中心测量了DHEAS水平的395例肾上腺占位性病变患者。他们被分为肾上腺库欣综合征（ACS）组（=100）和非ACS组（=295）。前者又分为产生皮质醇的肾上腺腺瘤（CPA）组（=67）和原发性双侧大结节性肾上腺增生（PBMAH）组（=33）。收集每组的临床资料，并通过独立样本t检验、卡方检验和曼-惠特尼检验进行组间比较。进一步构建校正年龄和性别的血清DHEAS比值，以确定不同肾上腺占位的受试者工作特征曲线和最佳切点值。ACS组患者年龄较小（44.9±13.7岁 vs. 49.9±12.5岁，P=0.001）；女性比例更高（79/100 vs.139/295，P=0.001）；且皮质醇水平更高[上午8∶00，497.31（343.52，606.50） vs. 353.11（267.50，487.91）nmol/L，P<0.001]，均高于非ACS组。ACS组的血清DHEAS水平和比值显著低于非ACS组[0.50（0.40，1.21） vs. 2.68（1.56，4.32）μmol/L，1.00（0.43，1.68） vs. 3.17（2.21，4.54），均P<0.001]。当血清DHEAS比值切点为1.29时，鉴别诊断ACS和非ACS的敏感性和特异性分别为72.0%和91.5%。CPA组的DHEAS比值低于PBMAH组[0.58（0.27，1.05） vs. 1.14（1.04，2.40），P=0.001]。当血清DHEAS比值切点为0.99时，鉴别诊断CPA和PBMAH的敏感性和特异性分别为64.2%和81.2%。校正年龄和性别的DHEAS比值可辅助肾上腺占位性病变的功能评估。
