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title alternative
サブクリニカルクッシング症候群における有意な夜間尿中遊離コルチゾールの排泄増加
creator
Shiwa, Tsuguka
NDC
Medical sciences
abstract
Objective: Absence of a late-night cortisol nadir is a consistent biochemical abnormality in patients with cortisol-producing adenoma. We evaluated the abnormality of late-night urinary free cortisol to creatinine ratio (late-night UFCCR) in patients with subclinical Cushing's syndrome (SCS). Methods: Fifty-eight patients with incidentally detected adrenocortical adenomas [SCS: 9; nonfunctioning adenoma (NF): 49] were enrolled as subjects. Values measured in all patients were urinary free cortisol accumulated between 9:00 p.m. and 11:00 p.m. (late-night UFCCR), serum cortisol at 11:00 p.m. (midnight serum cortisol: MSC), serum cortisol after 1-mg overnight dexamethasone suppression test (1 mg-DST) and 24-h urinary free cortisol (UFC). Results: Median late-night UFCCR value in SCS was significantly higher than that in NF (P < 0.001). Significant correlations were observed between late-night UFCCR and each of serum cortisol after 1 mg-DST and MSC (r = 0.537, P < 0.001 and r = 0.556, P < 0.001, respectively). There was no significant correlation between serum cortisol after 1 mg-DST and 24-h UFC (r = 0.211, P = 0.112). In receiver operating characteristic analysis for diagnosis of SCS, the areas under the curves of latenight UFCCR and 24-h UFC were 0.937 (95% confidence interval 0.865-1.008) and 0.726 (0.874-0.999), respectively. Late-night UFCCR cut-off value of 4.9 nmol/μmol Cre showed a sensitivity of 100% and a specificity of 76.6%. Conclusion: Patients with SCS showed higher late-night UFCCR values than those with NF. Late-night UFCCR was significantly correlated with autonomous cortisol production findings. Diagnostic performance of late-night UFCCR was superior to 24-h UFC. These results suggest that late-night UFCCR might represent one of the simple and reliable tests for SCS diagnosis.
language
eng
nii type
Thesis or Dissertation
HU type
Doctoral Theses
DCMI type
text
format
application/pdf
text version
ETD
relation references
Tsuguka Shiwa, Kenji Oki, Kiminori Yamane, Masayasu Yoneda, Tomokazu Awaya, Shuhei Nakanishi and Nobuoki Kohno; Significantly high level of late-night free cortisol to creatinine ratio in urine specimen in patients with subclinical Cushing's syndrome; Clinical Endocrinology, Volume 79, Issue 5, pages 617-622, November 2013 (doi: 10.1111/cen.12197)
relation references URL
http://doi.org/10.1111/cen.12197
grantid
甲第6270号
degreeGrantor
広島大学(Hiroshima University)
degreename Ja
博士(医学)
degreename En
Philosophy in Medical Science
degreelevel
doctoral
date of granted
2013-11-28
department
Graduate School of Biomedical Science