Saini Jasmine, Salama Bahaa, Yu Kai, Chacko Shireen R, Han Ashley J, Villavicencio Torres Camila, Murad Mohammad Hassan, Bancos Irina
Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN 55905, USA.
Department of Internal Medicine, Yale New Haven Hospital, New Haven, CT 06510, USA.
J Endocr Soc. 2025 Aug 20;9(9):bvaf136. doi: 10.1210/jendso/bvaf136. eCollection 2025 Sep.
Data on diagnostic accuracy of dehydroepiandrosterone sulfate (DHEA-S) for mild autonomous cortisol secretion (MACS) and adrenal insufficiency (AI) are discrepant.
We conducted a systematic review and meta-analysis of published studies assessing the accuracy of DHEA-S in diagnosing MACS or AI.
From inception to January 8, 2024, we searched databases for original studies of at least 20 participants with MACS or AI. MACS was defined as postdexamethasone cortisol greater than 1.8 mcg/dL or postsurgical hypocortisolism. AI was defined by abnormal dynamic testing. QUADAS-2 was used to assess the risk of bias. Bivariate random effects meta-analysis was used to generate pooled diagnostic accuracy estimates.
Seven studies on DHEA-S accuracy in diagnosing MACS (574 patients with MACS, 830 referent individuals), and 2 studies on DHEA-S accuracy in diagnosing AI (52 patients with AI, 59 referent individuals) were included. A meta-analysis of studies using DHEA-S cutoff between 60 and 70 mcg/dL to diagnose MACS demonstrated a sensitivity of 82% (95% CI, 64%-93%) and a specificity of 82% (95% CI, 74%-88%). In the 2 studies evaluating DHEA-S in diagnosing AI, the reference standard was a 1-mcg cosyntropin stimulation test. The sensitivity of DHEA-S for diagnosing AI ranged from 70.3% to 86.7%, and the specificity was 87.1%. Most studies were at a moderate risk of bias.
Based on limited heterogeneous evidence, measurement of DHEA-S provides additional value in diagnosing MACS, as well as AI.
硫酸脱氢表雄酮（DHEA-S）用于诊断轻度自主性皮质醇分泌（MACS）和肾上腺皮质功能不全（AI）的诊断准确性数据存在差异。
我们对已发表的评估DHEA-S诊断MACS或AI准确性的研究进行了系统评价和荟萃分析。
从研究开始至2024年1月8日，我们在数据库中检索了至少有20名MACS或AI患者的原始研究。MACS定义为地塞米松后皮质醇大于1.8 mcg/dL或术后皮质醇减退。AI通过异常动态试验定义。使用QUADAS-2评估偏倚风险。采用双变量随机效应荟萃分析生成合并诊断准确性估计值。
纳入了7项关于DHEA-S诊断MACS准确性的研究（574例MACS患者，830例对照个体），以及2项关于DHEA-S诊断AI准确性的研究（52例AI患者，59例对照个体）。对使用60至70 mcg/dL的DHEA-S临界值诊断MACS的研究进行荟萃分析，结果显示敏感性为82%（95%CI，64%-93%），特异性为82%（95%CI，74%-88%）。在2项评估DHEA-S诊断AI的研究中，参考标准为1 mcg促肾上腺皮质激素刺激试验。DHEA-S诊断AI的敏感性范围为70.3%至86.7%，特异性为87.1%。大多数研究存在中度偏倚风险。
基于有限的异质性证据，DHEA-S的测量在诊断MACS和AI方面具有额外价值。
