title: Low DHEAS: A Sensitive and Specific Test for the Detection of Subclinical Hypercortisolism in Adrenal Incidentalomas.
abstract: BACKGROUND
  Subclinical hypercortisolism (SH) occurs in 5% to 30% of adrenal incidentalomas (AIs). Common screening tests for adrenocorticotropin-independent hypercortisolism have substantial false-positive rates, mandating further time and resource-intensive investigations.
  
  
  OBJECTIVE
  To determine whether low basal dehydroepiandrosterone sulfate (DHEAS) is a sensitive and specific screening test for SH in AI.
  
  
  METHODS
  In total, 185 patients with AI were screened for adrenal medullary (plasma metanephrines) and cortical [1 mg overnight dexamethasone suppression test (ONDST), 24-hour urinary free cortisol (UFC), serum DHEAS, plasma renin, and aldosterone] hyperfunction. Positive ONDST [≥1.8 mcg/dL (≥50 nmol/L)] and/or UFC (more than the upper limit of reference range) results were further investigated. We diagnosed SH when at least 2 of the following were met: raised UFC, raised midnight serum cortisol, 48-hour dexamethasone suppression test (DST) cortisol ≥1.8 mcg/dL (≥50 nmol/L).
  
  
  RESULTS
  29 patients (16%) were diagnosed with SH. Adrenocorticotropin was <10 pg/mL (<2.2 pmol/L) in all patients with SH. We calculated age- and sex-specific DHEAS ratios (derived by dividing the DHEAS by the lower limit of the respective reference range) for all patients. Receiver operating characteristic curve analyses demonstrated that a ratio of 1.12 was sensitive (>99%) and specific (91.9%) for the diagnosis of SH. Cortisol following 1 mg ONDST of 1.9 mcg/dL (53 nmol/L) was a sensitive (>99%) screening test for SH but had lower specificity (82.9%). The 24-hour UFC lacked sensitivity (69%) and specificity (72%).
  
  
  CONCLUSIONS
  A single basal measurement of DHEAS offers comparable sensitivity and greater specificity to the existing gold-standard 1 mg DST for the detection of SH in patients with AIs.
authors: Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, and Departments of.
authors: M Conall
authors: MC
authors: Dennedy
authors: Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, and Departments of.
authors: Anand K
authors: AK
authors: Annamalai
authors: Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, and Departments of.
authors: Olivia
authors: O
authors: Prankerd-Smith
authors: Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, and Departments of.
authors: Natalie
authors: N
authors: Freeman
authors: Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, and Departments of.
authors: Kuhan
authors: K
authors: Vengopal
authors: Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, and Departments of.
authors: Johann
authors: J
authors: Graggaber
authors: Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, and Departments of.
authors: Olympia
authors: O
authors: Koulouri
authors: Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, and Departments of.
authors: Andrew S
authors: AS
authors: Powlson
authors: Radiology, and.
authors: Ashley
authors: A
authors: Shaw
authors: Clinical Biochemistry, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK.
authors: David J
authors: DJ
authors: Halsall
authors: Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, and Departments of.
authors: Mark
authors: M
authors: Gurnell
mesh_terms: D000236:Adenoma / Q000097:blood / Q000175:diagnosis; D000293:Adolescent; D000306:Adrenal Cortex Neoplasms / Q000097:blood* / Q000175:diagnosis; D000310:Adrenal Gland Neoplasms / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D018268:Adrenocortical Carcinoma / Q000097:blood* / Q000175:diagnosis; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000450:Aldosterone / Q000097:blood; D003480:Cushing Syndrome / Q000097:blood* / Q000175:diagnosis / Q000209:etiology; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood*; D003907:Dexamethasone; D005260:Female; D005938:Glucocorticoids; D006801:Humans; D006854:Hydrocortisone / Q000097:blood* / Q000652:urine; D006929:Hyperaldosteronism / Q000097:blood* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000097:blood / Q000175:diagnosis; D012372:ROC Curve; D012083:Renin / Q000097:blood; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D000450:Aldosterone; D019314:Dehydroepiandrosterone Sulfate; D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone; D012083:Renin; D006854:Hydrocortisone