Lin C L, Wu T J, Machacek D A, Jiang N S, Kao P C
Department of Laboratory Medicine and Pathology, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
J Clin Endocrinol Metab. 1997 Jan;82(1):151-5. doi: 10.1210/jcem.82.1.3687.
To determine the efficacy of cortisol and its metabolite, cortisone, measured simultaneously by high performance liquid chromatography (HPLC) in the diagnosis of Cushing's syndrome, we retrospectively reviewed the histories of 29 surgically proven Cushing's syndrome patients (20 Cushing's disease, 5 ectopic ACTH syndrome, and 4 adrenal Cushing's syndrome) and 6 patients with exogenous Cushing's syndrome. These 35 patients had urinary free cortisol determined by both HPLC and competitive binding methods. The efficacy of the HPLC assay using cortisol alone was equivalent to that of the competitive binding assay; 22 of 29 (76%) patients had increased cortisol. Cortisone also aided in the diagnosis; 25 of 29 (86%) had increased cortisone. Twenty-seven of the 29 (93%) patients had either both cortisone and cortisol (n = 19) or at least 1 of the 2 (n = 8) increased. All 6 patients with exogenous Cushing's syndrome had suppressed urinary free cortisol, cortisone, and the presence of prednisone and prednisolone. In the competitive binding assay, all exogenous Cushing's patients had falsely increased cortisol results. In conclusion, urinary free cortisol plus cortisone determined simultaneously by HPLC added a new dimension to the diagnosis of Cushing's syndrome. It should be considered when exogenous Cushing's syndrome is suspected or when only one urinary cortisol test is allowed to be ordered.
为了确定通过高效液相色谱法（HPLC）同时测定皮质醇及其代谢产物可的松在库欣综合征诊断中的效能，我们回顾性分析了29例经手术证实的库欣综合征患者（20例库欣病、5例异位促肾上腺皮质激素综合征和4例肾上腺库欣综合征）以及6例外源库欣综合征患者的病史。这35例患者的尿游离皮质醇通过HPLC法和竞争性结合法测定。单独使用皮质醇的HPLC测定法的效能与竞争性结合测定法相当；29例患者中有22例（76%）皮质醇升高。可的松也有助于诊断；29例中有25例（86%）可的松升高。29例患者中有27例（93%）可的松和皮质醇两者均升高（n = 19）或两者中至少1种升高（n = 8）。所有6例外源库欣综合征患者的尿游离皮质醇、可的松均降低，且存在泼尼松和泼尼松龙。在竞争性结合测定中，所有外源库欣综合征患者的皮质醇结果均假性升高。总之，通过HPLC同时测定尿游离皮质醇和可的松为库欣综合征的诊断增添了新的维度。当怀疑外源库欣综合征或仅允许进行一次尿皮质醇检测时，应考虑采用该方法。
