夜间唾液皮质醇是一种准确的无创检测方法,可用于评估肥胖儿童的内源性皮质醇过多症和疑似库欣综合征的临床表型。

IF 2.6 3区 医学 Q3 ENDOCRINOLOGY & METABOLISM
María Gabriela Ballerini, Analía Verónica Freire, María Eugenia Rodríguez, Luciana Brenzoni, Luciana Daga, Laura Castro, Ana Carolina Arias Cau, Graciela Testa, Melina Gil, Débora Braslavsky, Ana Vieites, Ana Keselman, Ignacio Bergadá, Andrea Josefina Arcari, María Gabriela Ropelato
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引用次数: 0

摘要

简介库欣综合征(CS)是儿科内分泌专家最具挑战性的诊断评估之一。一些外源性肥胖症患儿的临床表现与皮质醇分泌过多症的临床表现重叠。为避免肥胖症患者出现假阳性结果,准确、无创的一线检测是必要的。我们旨在评估唾液皮质醇在评估肥胖儿童内源性皮质醇增多症和库欣综合征临床重叠症状时的诊断准确性:病例对照研究:研究对象为2-18岁儿童,BMI-SDS≥2.0,随访2年。患者被分为三类:A组,具有儿童CS的明显特征(生长发育迟缓,体重增加);B组,具有CS的提示特征(如月牙脸和条纹);C组,与CS重叠的不太明显的特征(如高血压、多毛症、胰岛素抵抗)。A 类和 B 类儿童组成对照组。10 名确诊 CS 的患者为病例组。所有儿童都在同一天早上 7-8 点(晨唾皮质醇:mSC)和晚上 11 点(夜间唾液皮质醇:nSC)采集唾液样本。mSC 和 nSC 的结果用于计算夜间皮质醇下降的百分比(%D)。nSC和%D的ROC主要结果是灵敏度、特异性、阳性预测值(P)和阴性预测值(N)及其相应的95%IC。唾液皮质醇采用电化学发光法测定(定量下限:2.0 nmol/L):结果:75/112 名儿童符合纳入标准,22/75 名儿童符合对照组标准。与 mSC [6.9 (4.8-10.4) nmol/L] 相比,只有对照组的 nSC [中位数和四分位数间距:2.0 (2.0-2.5) nmol/L]有所下降,p< 0.0001。nSC≥8 nmol/L 的临界值在灵敏度:1.0(0.69-1.0)、特异性:1.0(0.85-1.0)、PPV:1.0(0.69-0.99)和 NPV:1.0(0.85-0.99)范围内确认 CS,诊断效率达到 100%。%D的临界值为50%。没有一名CS患儿的皮质醇百分比≥50%,但对照组中有6/22名患儿的皮质醇百分比低于临界值,因此与nSC相比,CS患儿的总体诊断准确率较低,仅为81%:结论:晚上11点唾液皮质醇是评估肥胖和临床怀疑库欣综合征儿童内源性皮质醇过多的一种准确、可行和无创的一线检测方法。nSC 还有助于显示皮质醇的昼夜节律在外源性肥胖儿童中得以保留。对于 nSC≥8.0 nmol/L 的患者,需要进行其他生化评估和影像学研究,以进一步确认病因。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Nocturnal Salivary Cortisol Is an Accurate Non-Invasive Test to Assess Endogenous Hypercortisolism in Children with Obesity and a Clinical Phenotype Suspicious for Cushing's Syndrome.

Introduction: Cushing's syndrome (CS) constitutes one of the most challenging diagnostic assessments for paediatric endocrinologists. The clinical presentation of some children with exogenous obesity overlaps with those observed in hypercortisolism states. Accurate, non-invasive first-line tests are necessary to avoid false-positive results in the obese. We aimed to evaluate the diagnostic accuracy of salivary cortisol to assess endogenous hypercortisolism in children with obesity and clinical overlapping signs of CS.

Methods: Case-control study that included children aged 2-18 years, BMI-SDS ≥2.0 and a follow-up >2 years. Patients were assigned to three categories: group A, features strongly indicative of paediatric CS (growth failure combined with increasing weight); group B, features suggestive of CS (e.g., moon face and striae); and group C, less specific features overlapping with CS (e.g., hypertension, hirsutism, insulin resistance). Children in categories A and B formed the control group. Ten patients with confirmed CS were the case group. All children collected saliva samples on the same day in the morning between 7 and 8:00 a.m. (morning salivary cortisol: mSC) and at 11 p.m. (nocturnal salivary cortisol: nSC). The mSC and nSC results were used to calculate the percentage decrease of cortisol at night (%D). Main outcomes by receiver operating characteristic for nSC and the %D were sensitivity, specificity, positive (P) and negative (N) predictive values (PV) and their corresponding 95% CI. Salivary cortisol was measured by electrochemiluminescence assay (lower limit of quantification: 2.0 nmol/L).

Results: 75/112 children met the inclusion criteria, whereas 22/75 children were eligible for the control group. Only controls decreased nSC (median and interquartile range: 2.0 [2.0-2.5] nmol/L) compared to mSC (6.9 [4.8-10.4] nmol/L), p < 0.0001. A cut-off for nSC ≥8 nmol/L confirmed CS within a sensitivity: 1.0 (0.69-1.0), specificity: 1.0 (0.85-1.0), PPV: 1.0 (0.69-0.99), and NPV: 1.0(0.85-0.99), achieving a diagnostic efficiency of 100%. The cut-off obtained for %D was 50%. No child with CS had a %D ≥50%, but 6/22 children in the control group had a %D below the cut-off, resulting in a lower overall diagnostic accuracy of 81% compared to nSC.

Conclusion: Salivary cortisol at 11 p.m. is an accurate, feasible, and non-invasive first-line test to assess endogenous hypercortisolism in children with obesity and clinical suspicion of CS. The nSC was also useful in showing that the circadian rhythm of cortisol was preserved in children with exogenous obesity. In patients with nSC ≥8.0 nmol/L, other biochemical assessments and imaging studies are needed to further confirm the aetiology.

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来源期刊
Hormone Research in Paediatrics
Hormone Research in Paediatrics ENDOCRINOLOGY & METABOLISM-PEDIATRICS
CiteScore
4.90
自引率
6.20%
发文量
88
审稿时长
4-8 weeks
期刊介绍: The mission of ''Hormone Research in Paediatrics'' is to improve the care of children with endocrine disorders by promoting basic and clinical knowledge. The journal facilitates the dissemination of information through original papers, mini reviews, clinical guidelines and papers on novel insights from clinical practice. Periodic editorials from outstanding paediatric endocrinologists address the main published novelties by critically reviewing the major strengths and weaknesses of the studies.
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