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对于中枢上腺功能不充分的低剂量共热素刺激试验的诊断效用
Cesare Morgante1,2, Kanthi Bangalore Krishna1,3, Erika McCann1
1Division of Pediatric Endocrinology, UPMC Children's Hospital, Pittsburgh, Pennsylvania, USA.
Hormone research in paediatrics
|January 6, 2025
概括
低剂量共热素测试 (LDT) 准确评估儿科垂体 - 上腺轴的功能. 将较低的切断值应用于LDT,可以获得与高剂量测试 (HDT) 相似的结果,用于诊断 adrenocorticotropic激素缺乏症.
科学领域:
- 儿科内分泌学 儿科内分泌学
- 内分泌诊断的诊断方法
- 下垂体 - 上腺轴评估
背景情况:
- 缺乏关于儿童低剂量辅热素测试 (LDT) 诊断截止值的共识.
- 与高剂量测试 (HDT) 相比,LDT在评估垂体-上腺轴上的优势需要进一步阐明.
研究的目的:
- 为了确定儿童LDT的最佳诊断截止值.
- 将LDT与HDT的诊断准确度进行比较,以评估上腺皮质激素缺乏症 (ACTHD).
主要方法:
- 对112名接受连续LDT和HDT的患者进行了回顾性研究.
- 根据测试原因将患者分为几组:长期暴露于葡萄糖皮质激素或疑似垂体功能障碍.
- 接收器操作特征 (ROC) 曲线分析用于确定LDT皮质醇水平与HDT相比的敏感性和特异性,作为参考标准.
主要成果:
- 在LDT和HDT的皮质醇峰值水平之间观察到强烈的相关性 (r=0.93).
- 一个LDT皮质醇峰切线13.5μg/dL显示高的诊断准确性 (90%的灵敏度,90%的特异性,AUC0.973) 的ACTHD.
- 对于长期暴露于葡萄糖皮质类药物和疑似垂体功能障碍的患者,建议使用不同的切断值.
结论:
- LDT可以提供与HDT可比的结果,用于评估儿科垂体 - 上腺轴的功能.
- 降低LDT的诊断截止值可以提高其诊断ACTHD的准确性.
- 这些发现支持LDT在儿科内分泌诊断中具有调整的切断值的实用性.
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