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

2016; Oxford University Press; Linguagem: Inglês

10.1210/jc.2016-2718

1945-7197

Michael Conall Dennedy, Anand K. Annamalai, Olivia Prankerd Smith, Natalie Freeman, Kuhan Vengopal, Johann Graggaber, Olympia Koulouri, Andrew S. Powlson, Ashley Shaw, David Halsall, Mark Gurnell,

Pituitary Gland Disorders and Treatments

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 was <10 pg/mL ( 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.