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Plasma steroid profiles in subclinical compared to overt adrenal Cushing's syndrome


Masjkur, Jimmy; Gruber, Matthias; Peitzsch, Mirko; Kaden, Denise; Di Dalmazi, Guido; Bidlingmaier, Martin; Zopp, Stephanie; Langton, Katharina; Fazel, Julia; Beuschlein, Felix; Bornstein, Stefan Richard; Reincke, Martin; Eisenhofer, Graeme (2019). Plasma steroid profiles in subclinical compared to overt adrenal Cushing's syndrome. Journal of Clinical Endocrinology & Metabolism, 104(10):4331-4340.

Abstract

CONTEXT Diagnosis of subclinical adrenal hypercortisolism is based on several tests of the hypothalamic-pituitary-adrenal axis to establish mild alterations of cortisol secretion and dysregulated cortisol physiology.
OBJECTIVE This study assessed whether plasma steroid profiles might assist diagnosis of subclinical Cushing's syndrome (SC).
DESIGN Retrospective cross-sectional study.
SETTING Two tertiary medical centers.
PATIENTS Two hundred and eight patients were tested for hypercortisolism among whom disease was excluded in 152 and confirmed in 21 with overt clinical Cushing's syndrome due to adrenal tumors (AC) compared to 35 with SC. Another 277 age- and gender-matched hypertensive and normotensive volunteers were included for reference.
MAIN OUTCOME MEASURES Panel of 15 plasma steroids measured by mass spectrometry with classification by discriminant analysis.
RESULTS Patients with SC showed lower (P<0.05) plasma concentrations of dehydroepiandrosterone and dehydroepiandrosterone-sulfate than subjects without SC. The largest increases (P<0.001) in plasma steroids among patients with SC were observed for 11-deoxycortisol and 11-deoxycorticosterone. Nevertheless, concentrations of 11-deoxycorticosterone, 11-deoxycortisol and pregnenolone in patients with AC were higher (P<0.05) than in those with SC. Patients with SC or AC could be distinguished from subjects without disease using the above combination of steroids as precisely as with use of measurements of serum cortisol after dexamethasone. The steroid combination provided superior diagnostic performance compared to each of the other routine biochemical tests.
CONCLUSIONS Distinct plasma steroid profiles in patients with SC may provide a simple and reliable screening method for establishing the diagnosis.

Abstract

CONTEXT Diagnosis of subclinical adrenal hypercortisolism is based on several tests of the hypothalamic-pituitary-adrenal axis to establish mild alterations of cortisol secretion and dysregulated cortisol physiology.
OBJECTIVE This study assessed whether plasma steroid profiles might assist diagnosis of subclinical Cushing's syndrome (SC).
DESIGN Retrospective cross-sectional study.
SETTING Two tertiary medical centers.
PATIENTS Two hundred and eight patients were tested for hypercortisolism among whom disease was excluded in 152 and confirmed in 21 with overt clinical Cushing's syndrome due to adrenal tumors (AC) compared to 35 with SC. Another 277 age- and gender-matched hypertensive and normotensive volunteers were included for reference.
MAIN OUTCOME MEASURES Panel of 15 plasma steroids measured by mass spectrometry with classification by discriminant analysis.
RESULTS Patients with SC showed lower (P<0.05) plasma concentrations of dehydroepiandrosterone and dehydroepiandrosterone-sulfate than subjects without SC. The largest increases (P<0.001) in plasma steroids among patients with SC were observed for 11-deoxycortisol and 11-deoxycorticosterone. Nevertheless, concentrations of 11-deoxycorticosterone, 11-deoxycortisol and pregnenolone in patients with AC were higher (P<0.05) than in those with SC. Patients with SC or AC could be distinguished from subjects without disease using the above combination of steroids as precisely as with use of measurements of serum cortisol after dexamethasone. The steroid combination provided superior diagnostic performance compared to each of the other routine biochemical tests.
CONCLUSIONS Distinct plasma steroid profiles in patients with SC may provide a simple and reliable screening method for establishing the diagnosis.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Endocrinology and Diabetology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:1 October 2019
Deposited On:24 Apr 2019 11:57
Last Modified:25 Sep 2019 00:33
Publisher:Oxford University Press
ISSN:0021-972X
OA Status:Closed
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1210/jc.2018-02349
PubMed ID:30977834

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