Low DHEAS: A Sensitive and Specific Test for Detection of Subclinical Hypercortisolism in Adrenal Incidentalomas

Autor: Ashley Shaw, David Halsall, Olivia Prankerd-Smith, Kuhan Vengopal, Anand K. Annamalai, Andrew S Powlson, Johann Graggaber, Olympia Koulouri, M Conall Dennedy, Mark Gurnell, Natalie Freeman
Rok vydání: 2016
Předmět:
Male
Hydrocortisone
Endocrinology
Diabetes and Metabolism
Clinical Biochemistry
Adrenal Gland Neoplasms
Biochemistry
Plasma renin activity
Dexamethasone
chemistry.chemical_compound
0302 clinical medicine
Endocrinology
Renin
Adrenocortical Carcinoma
Medicine
Aldosterone
Cushing Syndrome
Dehydroepiandrosterone Sulfate
Middle Aged
030220 oncology & carcinogenesis
Dexamethasone suppression test
Female
hormones
hormone substitutes
and hormone antagonists
medicine.drug
Adenoma
Adult
endocrine system
medicine.medical_specialty
Adolescent
030209 endocrinology & metabolism
Context (language use)
Pheochromocytoma
Sensitivity and Specificity
Young Adult
03 medical and health sciences
Dehydroepiandrosterone sulfate
Adrenocorticotropic Hormone
Internal medicine
Hyperaldosteronism
Humans
Glucocorticoids
Metanephrine
Retrospective Studies
business.industry
Biochemistry (medical)
Metanephrines
Adrenal Cortex Neoplasms
ROC Curve
chemistry
business
Zdroj: The Journal of Clinical Endocrinology & Metabolism. :jc.2016-2718
ISSN: 1945-7197
0021-972X
Popis: Subclinical hypercortisolism (SH) occurs in 5% to 30% of adrenal incidentalomas (AIs). Common screening tests for adrenocorticotropin-independent hypercortisolism have substantial false-positive rates, mandating further time and resource-intensive investigations.To determine whether low basal dehydroepiandrosterone sulfate (DHEAS) is a sensitive and specific screening test for SH in AI.In total, 185 patients with AI were screened for adrenal medullary (plasma metanephrines) and cortical [1 mg overnight dexamethasone suppression test (ONDST), 24-hour urinary free cortisol (UFC), serum DHEAS, plasma renin, and aldosterone] hyperfunction. Positive ONDST [≥1.8 mcg/dL (≥50 nmol/L)] and/or UFC (more than the upper limit of reference range) results were further investigated. We diagnosed SH when at least 2 of the following were met: raised UFC, raised midnight serum cortisol, 48-hour dexamethasone suppression test (DST) cortisol ≥1.8 mcg/dL (≥50 nmol/L).29 patients (16%) were diagnosed with SH. Adrenocorticotropin was10 pg/mL (2.2 pmol/L) in all patients with SH. We calculated age- and sex-specific DHEAS ratios (derived by dividing the DHEAS by the lower limit of the respective reference range) for all patients. Receiver operating characteristic curve analyses demonstrated that a ratio of 1.12 was sensitive (99%) and specific (91.9%) for the diagnosis of SH. Cortisol following 1 mg ONDST of 1.9 mcg/dL (53 nmol/L) was a sensitive (99%) screening test for SH but had lower specificity (82.9%). The 24-hour UFC lacked sensitivity (69%) and specificity (72%).A single basal measurement of DHEAS offers comparable sensitivity and greater specificity to the existing gold-standard 1 mg DST for the detection of SH in patients with AIs.
Databáze: OpenAIRE
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