扩大轻度自主皮质醇分泌的临床概况:新的诊断标记物和新出现的并发症
Antonio Prinzi1, Ausilia Maria Lombardo2, Salvatore Finocchiaro2
1Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Medical Center, Catania, Italy; Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo, Italy.
概括
轻度自主皮质醇分泌 (MACS) 与神经精神病和生殖腺问题有关. 一个新的生物化学分数和深夜的皮质醇水平可能有助于诊断MACS,特别是当甲松抑制试验 (DST) 不清楚时.
科学领域:
- 内分泌学 在内分泌学.
- 上腺腺疾病 上腺疾病
- 生物化学标记物 生物化学标记物
背景情况:
- 轻度自主皮质醇分泌 (MACS) 是上腺意外瘤 (AI) 的常见发现.
- 诊断MACS存在挑战,需要使用替代诊断方法.
- 了解MACS和非功能AI之间的临床和生化差异至关重要.
研究的目的:
- 为了比较患有MACS和非功能AI的患者的临床和生化资料.
- 确定可靠的生物标志物,可以帮助诊断MACS.
- 评估用于MACS诊断的1毫克德甲抑制试验 (DST) 的潜在替代方案.
主要方法:
- 对171名AI患者的回顾性分析 (70名MACS,101名非功能AI).
- 通过DST皮质醇>1.8μg/dL而定义的MACS,没有明显的库辛综合征.
- 在MACS和非功能AI组之间比较临床特征和生化参数.
主要成果:
- 在MACS患者中,血脂不良和焦虑抑郁症的发病率更高.
- 生物化学差异包括MACS中较低的ACTH,DHEA-S和 (男性).
- 在MACS中观察到较高的DST后皮质醇,24小时无尿皮质醇和深夜血清皮质醇.
- 结合ACTH <15 pg/mL和DHEA-S <0.5 μg/mL的诊断评分显示出高准确度 (AUC:0.78).
- 夜间皮质醇≥5.1μg/dL显示出良好的诊断准确性 (AUC:0.83) 并与并发症相关.
结论:
- 马克斯与神经精神和淋巴腺功能障碍有关.
- 一个简单的生化评分和深夜的皮质醇水平可以支持MACS诊断.
- 这些标记在DST结果不确切或在住院患者中特别有用.
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