在家醒来唾液皮质激素检查上腺功能不全
Miguel Debono1,2, Charlotte J Elder2, Jen Lewis3
1Department of Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom.
NEJM evidence
|February 6, 2024
概括
家庭唾液皮质激素测试准确地查上腺功能不充分,为临床上腺皮质激素 (ACTH) 刺激测试提供了一种方便的替代方案. 这种方法提供了可比的诊断信息,大多数患者更喜欢这种方法.
科学领域:
- 内分泌学 在内分泌学.
- 诊断医学 诊断医学 诊断医学
- 生物化学 生物化学
背景情况:
- 上腺功能衰竭是一个全球性的健康问题,通常是由于使用葡萄糖皮质醇/阿片类药物或感染引起的.
- 标准的上腺皮质激素 (ACTH) 刺激测试需要临床访问和静脉切割.
- 唾液皮质醇提供了一个非侵入性的替代品,反映血清皮质醇水平,并使得家庭样本采集.
研究的目的:
- 为了评估基于家庭的清醒唾液皮质子水平的准确性,以查上腺功能不充分.
- 为了比较唾液皮质激素测试的诊断性能与已建立的ACTH刺激测试.
主要方法:
- 一项前性诊断准确性研究,涉及220名高风险患者.
- 在接受临床ACTH刺激测试之前,患者在醒来时收集了家庭唾液样本.
- 用液体染色学并联质谱法量化唾液皮质子.
主要成果:
- 通过ACTH测试,上腺功能缺陷的患病率为44%.
- 清醒时的唾液皮质醇显示了对上腺功能不充分的高诊断准确性 (AUC 0.95).
- 优化的切断值产生了95%的灵敏度和特异性,具有高的预测值.
结论:
- 在家醒着的唾液皮质激素采样是诊断上腺功能不全的非常准确的方法.
- 这种在家测试方法的准确性与标准的ACTH刺激测试相美.
- 大多数患者更喜欢在家收集唾液的方便性,而不是去医院检查.
相关概念视频
Adrenal Gland Disorders
1.5K
Adrenal gland disorders manifest when the production of adrenal hormones deviates from the norm, resulting in either excessive or insufficient concentrations.
Adrenal insufficiency, characterized by insufficient cortisol and aldosterone production, leads to conditions like Addison's disease. This disorder, affecting the adrenal cortex, exhibits symptoms such as skin bronzing, dehydration, low blood pressure, fatigue, and weight loss. Congenital adrenal hyperplasia, a genetic ailment causing...
Adrenal insufficiency, characterized by insufficient cortisol and aldosterone production, leads to conditions like Addison's disease. This disorder, affecting the adrenal cortex, exhibits symptoms such as skin bronzing, dehydration, low blood pressure, fatigue, and weight loss. Congenital adrenal hyperplasia, a genetic ailment causing...
1.5K
Hypothalamic-Pituitary Axis
60.0K
The response to stress—be it physical or psychological, acute or chronic—involves activation of the Hypothalamic-Pituitary-Adrenal (HPA) axis. The HPA axis is part of the neuroendocrine system because it involves both neuronal and hormonal communication. Its function is to regulate homeostatic systems—metabolic, cardiovascular, and immune—providing the necessary means to respond to a stressor.
60.0K
Hormones of the Adrenal Glands
2.5K
Adrenal hormones play a pivotal role in maintaining the body's electrolyte balance and orchestrating responses to stress, showcasing the intricate functions of the adrenal cortex and medulla.
The adrenal cortex, a powerhouse of hormone synthesis, generates over two dozen corticosteroid hormones. The zona glomerulosa produces mineralocorticoids, exemplified by aldosterone, influencing the electrolyte composition of body fluids. The synthesis of glucocorticoids such as cortisol and...
The adrenal cortex, a powerhouse of hormone synthesis, generates over two dozen corticosteroid hormones. The zona glomerulosa produces mineralocorticoids, exemplified by aldosterone, influencing the electrolyte composition of body fluids. The synthesis of glucocorticoids such as cortisol and...
2.5K
Anatomy of the Adrenal Glands
2.2K
The adrenal or supra-renal glands, situated above the kidneys and aligned with the twelfth rib, are paired pyramid-shaped structures crucial for the body's stress response. During stress, these glands secrete hormones vital for adaptive physiological reactions.
These glands possess a distinctive yellow tinge due to the stored cholesterol and fatty acids required for hormone synthesis. They are encased in a fibrous capsule and cushioned by fat.
The adrenal gland comprises two distinct...
These glands possess a distinctive yellow tinge due to the stored cholesterol and fatty acids required for hormone synthesis. They are encased in a fibrous capsule and cushioned by fat.
The adrenal gland comprises two distinct...
2.2K
Hypoglycemia and Glucagon
263
Without prolonged fasting, healthy individuals maintain blood glucose levels above 3.5 mM due to a well-adapted neuroendocrine counterregulatory system that effectively prevents acute hypoglycemia, a potentially life-threatening condition. The primary clinical scenarios for hypoglycemia encompass diabetes treatment, inappropriate production of endogenous insulin or insulin-like substances by tumors, and the use of glucose-lowering agents in non-diabetic individuals. Notably, hypoglycemia in the...
263
Physiological Foundation of Stress
59
Stress triggers a coordinated physiological response involving the sympathetic nervous system (SNS) and the hypothalamic-pituitary-adrenal (HPA) axis. This dual activation ensures that the body is prepared for both immediate and prolonged stress management. The process begins with the perception of a stressor. This initial phase activates the SNS, leading to the rapid release of adrenaline (epinephrine) from the adrenal glands.
Role of the Sympathetic Nervous System
Adrenaline triggers the...
Role of the Sympathetic Nervous System
Adrenaline triggers the...
59


