[1]李佳琦,孙丽思,余叶蓉.库欣综合征筛查试验的选择和临床应用[J].国际内分泌代谢杂志,2021,41(06):573-577.[doi:10.3760/cma.j.cn121383-20210831-08083]
　Li Jiaqi,Sun Lisi,Yu Yerong..Selection and clinical application of screening tests for Cushing's syndrome[J].International Journal of Endocrinology and Metabolism,2021,41(06):573-577.[doi:10.3760/cma.j.cn121383-20210831-08083]
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库欣综合征筛查试验的选择和临床应用()
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《国际内分泌代谢杂志》[ISSN:1673-4157/CN:12-1383/R]

卷:
41
期数:
2021年06期
页码:
573-577
栏目:
专家论坛
出版日期:
2021-12-20

文章信息/Info

Title:
Selection and clinical application of screening tests for Cushing's syndrome
作者:
李佳琦; 孙丽思; 余叶蓉
四川大学华西医院内分泌代谢科,成都 610041
Author(s):
Li Jiaqi;  Sun Lisi;  Yu Yerong.
Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu 610041, China
关键词:
库欣综合征;  高皮质醇血症;  地塞米松过夜抑制试验;  筛查试验
Keywords:
Cushing's syndrome;  Hypercortisolism;  Dexamethasone suppression test;  Screening tests
DOI:
10.3760/cma.j.cn121383-20210831-08083
摘要:
库欣综合征(CS)是由于多种病因所致循环血液中糖皮质激素水平持续增高从而产生的一组临床症候群,常包括肥胖、高血压和糖尿病。 CS患者长期存在的高糖皮质激素血症对生存率及生存质量影响极大,对疑似CS的患者选择恰当的筛查试验并合理解读试验结果对于CS的诊断至关重要。本文对CS的筛查方法选择及可能影响试验结果的因素进行了分析,并针对国内地塞米松制剂的剂量及国人的体重等因素,提出地塞米松抑制试验需注意的问题。重点强调临床医生应根据患者的具体情况选择恰当的筛查试验。
Abstract:
The clinical features of Cushing's syndrome such as obesity, hypertension, and diabetes are caused by elevated cortisol level. Long-term hyperglycocorticoidemia in patients with Cushing's syndrome(CS)has a great impact on the survival rate and quality of life of patients. Choosing the appropriate screening test for patients with suspected CS and interpreting the test results reasonably is essential for the diagnosis of CS. This article analyzes the selection of screening methods for CS and the factors that may affect the results of the test, and puts forward the issues that should be paid attention to in the dexamethasone suppression test for factors such as the dosage of domestic dexamethasone preparations and the weight of Chinese people. It is emphasized that clinicians should choose the appropriate screening test according to the specific situation of the patient.

参考文献/References:

[1] Clayton RN,Raskauskiene D,Reulen RC,et al.Mortality and morbidity in cushing's disease over 50 years in Stoke-on-Trent,UK:audit and meta-analysis of literature[J].J Clin Endocrinol Metab,2011,96(3):632-642.DOI:10.1210/jc.2010-1942.
[2] Webb SM,Crespo I,Santos A,et al.Management of endocrine disease:quality of life tools for the management of pituitary disease[J].Eur J Endocrinol,2017,177(1):R13-R26.DOI:10.1530/EJE-17-0041.
[3] Piasecka M,Papakokkinou E,Valassi E,et al.Psychiatric and neurocognitive consequences of endogenous hypercortisolism[J].J Intern Med,2020; 288(2):168-182.DOI:10.1111/joim.13056.
[4] Nieman LK,Biller BM,Findling JW,et al.The diagnosis of Cushing's syndrome:an endocrine society clinical practice guideline[J].J Clin Endocrinol Metab,2008,93(5):1526-1540.DOI:10.1210/jc.2008-0125.
[5] 中华医学会内分泌学分会.库欣综合征专家共识(2011年)[J].中华内分泌代谢杂志,2012,28(2):96-102.DOI:10.3760/cma.j.issn.1000-6699.2012.02.002.
[6] 中国垂体腺瘤协作组.中国库欣病诊治专家共识(2015)[J].中华医学杂志,2016,96(11):835-840.DOI:10.3760/cma.j.issn.0376-2491.2016.11.002.
[7] Nieman LK.Diagnosis of Cushing's syndrome in the modern era[J].Endocrinol Metab Clin North Am,2018,47(2):259-273.DOI:10.1016/j.ecl.2018.02.001.
[8] Fassnacht M,Arlt W,Bancos I,et al.Management of adrenal incidentalomas:European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors[J].Eur J Endocrinol,2016,175(2):G1-G34.DOI:10.1530/EJE-16-0467.
[9] Mericq MV,Cutler GB Jr.High fluid intake increases urine free cortisol excretion in normal subjects[J].J Clin Endocrinol Metab,1998,83(2):682-684.DOI:10.1210/jcem.83.2.4555.
[10] Findling JW,Raff H.Newer diagnostic techniques and problems in Cushing's disease[J].Endocrinol Metab Clin North Am,1999,28(1):191-210.DOI:10.1016/s0889-8529(05)70063-3.
[11] Arnaldi G,Angeli A,Atkinson AB,et al.Diagnosis and complications of Cushing's syndrome:a consensus statement[J].J Clin Endocrinol Metab,2003,88(12):5593-5602.DOI:10.1210/jc.2003-030871.
[12] Krieger DT,Allen W,Rizzo F,et al.Characterization of the normal temporal pattern of plasma corticosteroid levels[J].J Clin Endocrinol Metab,1971,32(2):266-284.DOI:10.1210/jcem-32-2-266.
[13] Refetoff S,Van Cauter E,Fang VS,et al.The effect of dexamethasone on the 24-hour profiles of adrenocorticotropin and cortisol in Cushing's syndrome[J].J Clin Endocrinol Metab,1985,60(3):527-535.DOI:10.1210/jcem-60-3-527.
[14] Read GF,Walker RF,Wilson DW,et al.Steroid analysis in saliva for the assessment of endocrine function[J].Ann N Y Acad Sci,1990,595:260-274.DOI:10.1111/j.1749-6632.1990.tb34300.x.
[15] Baid SK,Sinaii N,Wade M,et al,Nieman LK.Radioimmunoassay and tandem mass spectrometry measurement of bedtime salivary cortisol levels:a comparison of assays to establish hypercortisolism[J].J Clin Endocrinol Metab,2007,92(8):3102-3107.DOI:10.1210/jc.2006-2861.
[16] Viardot A,Huber P,Puder JJ,et al.Reproducibility of nighttime salivary cortisol and its use in the diagnosis of hypercortisolism compared with urinary free cortisol and overnight dexamethasone suppression test[J].J Clin Endocrinol Metab,2005,90(10):5730-5736.DOI:10.1210/jc.2004-2264.
[17] Oki Y,Hashimoto K,Hirata Y,et al.Development and validation of a 0.5 mg dexamethasone suppression test as an initial screening test for the diagnosis of ACTH-dependent Cushing's syndrome[J].Endocr J,2009,56(7):897-904.DOI:10.1507/endocrj.k09e-194.
[18] van Hulsteijn LT,Pasquali R,Casanueva F,et al.Prevalence of endocrine disorders in obese patients:systematic review and meta-analysis[J].Eur J Endocrinol,2020,182(1):11-21.DOI:10.1530/EJE-19-0666.
[19] Reincke M.Subclinical Cushing's syndrome[J].Endocrinol Metab Clin North Am,2000,29(1):43-56.DOI:10.1016/s0889-8529(05)70115-8.

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备注/Memo

备注/Memo:
通信作者:余叶蓉,Email:yerongyu@scu.edu.cn
更新日期/Last Update: 2021-12-10