全球精选文摘 - 对库欣综合征患者采用配伍药物治疗会使地塞米松/促肾上腺皮质激素释放激素联合试验结果的阐释复杂化

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对库欣综合征患者采用配伍药物治疗会使地塞米松/促肾上腺皮质激素释放激素联合试验结果的阐释复杂化

Concomitant Medication Use Can Confound Interpretation of the Combined Dexamethasone-Corticotropin Releasing Hormone Test in Cushing's Syndrome

Valassi E, Swearingen B, Lee H 2010/6/22 11:48:00

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J Clin Endocrinol Metab, 2009,

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Context:

The ability of combined dexamethasone-corticotropin releasing hormone (Dex-CRH) testing to distinguish pseudo-Cushing's syndrome (PCS) from Cushing's syndrome is controversial. One factor potentially impairing diagnostic efficacy is the concomitant use of commonly prescribed medications that may alter dexamethasone metabolism.

Objective:

Our objective was to assess the diagnostic accuracy of the Dex-CRH test and evaluate the potential impact of concomitant drugs.

Design:

The study was a retrospective one.

Participants:

Participants included 101 patients [60 Cushing's disease (CD); 41 PCS] who underwent 112 Dex-CRH tests. Patients were divided into two groups, depending on use of medications potentially interfering with dexamethasone metabolism: 58 tests were classified as No Meds (32 CD; 26 PCS) and 54 as Meds (34 CD; 20 PCS). The latter group was further subdivided into patients taking one medication vs. those taking multiple medications.

Main Outcome Measures:

Diagnostic accuracy of different serum cortisol and ACTH thresholds at baseline and 15min after CRH injection was assessed.

Results:

The specificity of a baseline post-low-dose-dexamethasone-suppressed test cortisol lower than 1.4μg/dl (38nmol/liter) was significantly higher in the No Meds vs. the Meds group (P=0.014). Sensitivity and specificity using a post-CRH cortisol cutoff of 1.4μg/dl (38nmol/liter) were 93.1% (95% confidence interval=88.4–97.8) and 92.3% (95% confidence interval=87–97.6) in the No Meds group. The specificity of a cortisol lower than 1.4μg/dl (38nmol/l) at 15min after CRH was significantly higher in patients taking only one medication vs. those on multidrug treatment (P<0.05).

Conclusions:

Medications commonly prescribed in hypercortisolemic patients undergoing Dex-CRH testing may contribute to the variable diagnostic accuracy of this test. Prospective studies to address this issue are needed.

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疾病资源中心

高血压	慢性阻塞性肺病
脂肪性肝病	糖尿病
卒中	肺癌
冠心病	子宫内膜异位症
结直肠癌	乳腺癌
心力衰竭	心律失常

病例分析 [栏目介绍]

甲状腺功能亢进合并黄疸

王燕燕王曙

上海交通大学附属瑞金医院内分泌科

患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。

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