背景:根据地塞米松后皮质醇>1.8mcg/dL诊断轻度自主皮质醇分泌(MACS)。在MACS中,关于类固醇昼夜节律分泌和类固醇代谢组的证据很少。
目的:研究MACS患者24小时(h)尿类固醇代谢组的特征,并确定MACS患者与参考受试者的尿类固醇谱和皮质醇浓度的昼夜节律差异。
方法:横断面研究,2018-2023年。
方法:转诊中心。
方法:患有MACS和年龄的患者,sex-,BMI-,和更年期状态匹配的参考对象。
方法:在24小时内收集尿液作为单独的白天和夜间收集。高分辨率质谱测定用于测量25种类固醇。每2小时对游离和总皮质醇进行血清测量,将患者和参考受试者分组。
结果:类固醇,sums,和比率。
结果:MACS患者(n=72)的mcg/24h中位数雄激素较低(2084vs3283,P<0.001),较高的糖皮质激素(15754vs12936,P<0.001),和更高的糖皮质激素/雄激素比率(8.7vs3.9,P<0.001),与引用主题相比。与参考受试者相比,患者的类固醇日/夜比率也较低,反映了MACS中相对夜间类固醇产量较高。在12名MACS患者和10名参考受试者的亚组中,总皮质醇和游离皮质醇的24小时曲线下面积相似.然而,晚上平均总数(5.3vs4.0mcg/dL,P=0.056)和游离(0.2vs0.1mcg/dL,P=0.035)患者的皮质醇高于参考受试者。
结论:MACS患者表现出异常的尿类固醇代谢组,糖皮质激素与雄激素的比例很高,和更高的夜间类固醇产量。
BACKGROUND: Mild autonomous cortisol secretion (MACS) is diagnosed based on post-dexamethasone cortisol>1.8 mcg/dL. Scarce evidence exists on steroid circadian secretion and steroid metabolome in MACS.
OBJECTIVE: To characterize 24-hour (h) urine steroid metabolome in patients with MACS and determine circadian differences in urine steroid profiling and cortisol concentrations in patients with MACS versus referent subjects.
METHODS: Cross-sectional study, 2018-2023.
METHODS: Referral center.
METHODS: Patients with MACS and age-, sex-, BMI-, and menopausal status-matched referent subjects.
METHODS: Urine was collected over 24h period as separate day- and night-time collections. High-resolution mass spectrometry assay was used to measure 25 steroids. A subgroup of patients and referent subjects were admitted for every 2h serum measurements of free and total cortisol.
RESULTS: Steroids, sums, and ratios.
RESULTS: Patients with MACS (n=72) had lower mcg/24h median androgens (2084 vs 3283, P<0.001), higher glucocorticoids (15754 vs 12936, P<0.001), and higher glucocorticoid/androgen ratio (8.7 vs 3.9, P<0.001), compared to referent subjects. Patients also had lower steroid day/night ratios compared to referent subjects, reflecting a higher relative nocturnal steroid production in MACS. In a subgroup of 12 patients with MACS and 10 referent subjects, the 24-hour area under the curves for total and free cortisol were similar. However, evening mean total (5.3 vs 4.0 mcg/dL, P=0.056) and free (0.2 vs 0.1 mcg/dL, P=0.035) cortisol was higher in patients vs referent subjects.
CONCLUSIONS: Patients with MACS demonstrate an abnormal urine steroid metabolome, with a high glucocorticoid to androgen ratio, and a higher nocturnal steroid production.