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Современный взгляд на скрининг и диагностику эндогенного гиперкортицизма

https://doi.org/10.14341/probl201258435-41

Аннотация

Обзор посвящен современным методам диагностики эндогенного гиперкортицизма. Наряду с эпидемиологическими данными и клинической картиной обсуждается выделение групп риска и выбор пациентов для скрининга. Основное внимание уделяется наиболее информативным диагностическим тестам, простым для выполнения и интерпретации (определение кортизола в суточной моче, малая проба с дексаметазоном, кортизол в вечерней слюне), оценке их чувствительности, специфичности и точек разделения. Детально описаны правила проведения и ограничения, свойственные каждому диагностическому тесту. Кроме того, предложен алгоритм проведения двух тестов и более с целью снижения максимальной чувствительности и специфичности результата. Методы скрининга ориентированы на врачей общей практики и смежных специальностей и должны использоваться для установления диагноза (но не определения генеза) эндогенного гиперкортицизма врачом-эндокринологом.

Список литературы

1. Cushing H.W. The pituitary body and its disorders. Philadelphia: JB Lippincott Co 1912.

2. Дедов И.И., Мельниченко Г.А. Болезнь Иценко-Кушинга. М: УП Принт 2011; 342.

3. Newell-Price J., Bertagna X., Grossman A.B., Nieman L.K. Cushing's Syndrome. Lancet 2006; 367: 1605-1617.

4. Pivonello R., De Martino M.C., De Leo M., Tauchmanova L., Faggiano A., Lombardi G., Colao A. Cushing's syndrome: Aftermath of the cure. Arq Bras Endocrinol Metab 2007; 51: 1381-1391.

5. Steffensen C., Bak A.M., Rubeck K.Z., Jorgensen J.O.L. Epidemiology of Cushing's syndrome. Neuroendocrinology 2010; 92: Suppl 1: 1-5.

6. Дедов И.И. Клиническая нейроэндокринология. М: УП Принт 2011; 343.

7. Boscaro M., Arnaldi G. Approach to the patient with possible Cushing's syndrome. J Clin Endocrinol Metabol 2009; 94: 3121-3131.

8. Finding J.W., Raff H. Clinical review: Cushing's syndrome: important issues in diagnosis and management. J Clin Endocrinol Metabol 2006; 91: 3746-3753.

9. Catagri B., Rigaleau V., Poussin A., Ronci-Chaix N., Bex V., Vegnot V., Gin H., Roger P., Tabarin A. Occult Cushing's syndrome in type-2 diabetes. J Clin Endocrinol Metabol 2003; 88: 5808-5813.

10. Leibowitz G., Tsur A., Chayen S.D., Salameh M., Raz I., Gerasi E., Gross D.J. Pre-clinical Cushing's syndrome an uexpected frequent cause of poor glycaemic control in obese diabetic patients. Clin Endocrinol (Oxford) 1996; 44: 717-722.

11. Chiodini I., Mascia M.L., Muscarella S., Battista C., Minisola S., Arosio M., Santini S.A., Guglielmi G., Carnevale V., Scillitani A. Subclinical hypercortisolism among outpatients referred for osteoporosis. Ann Intern Med 2007; 147: 541-548.

12. Omura M., Saito J., Yamaguchi K., Kakuta Y., Nishikawa T. Prospective study on the prevalence of secondary hypertension among hypertensive patients visiting a general outpatient clinic in Japan. Hypertens Res 2004; 27: 3: 193-202.

13. Moran C., Tapia M.C., Hemandez E., Vazquez G., Garcia-Hernandez E., Bermudez J.A. Etiological review of hirsutism in 250 patients. Arch Med Res 1994; 25: 311-314.

14. Plotz D., Knowlton A.I., Ragan C. The natural history of Cushing's disease. Am J Med 1952; 13: 597-614.

15. O'Riordain D.S., Farley D.R., Young W.F.Jr. et.al. Long-term outcome of bilateral adrenalectomy in patients with Cushing's syndrome. Surgery 1994; 116: 1088-1093.

16. Clyton R.N. Mortality in Cushing's disease. Neuroendocrinology 2010; 92: Suppl 1: 71-76.

17. Nieman L.K., Biller B.M.K., Finding J.W., Newell-Price J., Savage M.O., Stewart P.M., Montori V.M. The diagnosis of Cushing's syndrome: an endocrine society clinical practice guideline. J Clin Endocrinol Metabol 2008; 93: 1526-1540.

18. Crapo L. Cushing's syndrome: a review of diagnostic tests. Metabolism 1979; 28: 955-977.

19. Melby J.C. Assessment of adrenocortical function. New Engl J Medi 1971; 285: 735-739.

20. Alexandraki K.I., Grossman A.B. Is urinary free cortisol of value in the diagnosis of Cushing's syndrome. Curr Opin Endocrinol Diabet Obes 2011; 18: 259-263.

21. Deutschbein T., Broecker-Preuss M., Hartmann M.F., Althoff R., Wudy S.A., Mann K., Petersenn S. Measuremant of urinary free cortisol by current immunoassays:need for sex-dependent reference ranges to define hypercortisolism. Horm Metab Res 2011; 43: 714-719.

22. Kidambi S., Raff H., Finding J.W. Limitation of nocturnal salivary cortisol and urine free cortisol in the diagnosis of mild Cushing's syndrome. Eur J Endocrinol 2007; 157: 725-731.

23. Mericq M.V., Culter Jr.G.B. High fluid intake increases urine free free cortisol excretion in normal subjects. J Clin Endocrinol Metab 1998; 83: 682-684.

24. Chan K.C., Lit L.C., Law E.L., Tai M.H., Yung C.U., Chan M.H., Lam C.W. Diminished urinary free cortisol excretion in patients with moderate and severe renal impairement. Clin Chem 2004; 50: 757-759.

25. Newel-Price J., Trainer P., Besser M., Grossman A. The diagnosis and differential diagnosis of Cushing's syndrome and pseudo-Cushing's states. Endocrinol Rev 1998; 19: 647-672.

26. Wood P.J., Barth J.H., Freedman D.B., Perry L., Sheridan B. Evidence for the low dose dexamethasone suppression test to screen for Cushing's syndrome - recommendations for a protocol for biochemistry laboratotories. Ann Clin Biochem 1997; 34: Pt 3: 222-229.

27. Kyriazopoulou V., Vaginakis A.G. Abnormal overnight dexamethasone suppression test in subjects receiving rifampicin therapy. J Clin Endocrinol Metab 1992; 75: 315-317.

28. Nickelsen T., Lissner W., Schoffling K. The dexamethasone suppression test and long-term contraceptive treatment: measurement of ACTH or salivary cortisol does not improve the reliability of the test. Exp Clin Endocrinol 1989; 94: 280-375.

29. Krieger D.T., Allen W., Rizzo F., Krieger H.P. Characterization of the normal temporal pattern of plasma corticosteroid levels. J Clin Endocrinol Metab 1971; 32: 266-284.

30. Glass A.R., Zavadil A.P.Jr, Halberg F., Cornelissen G., Schaaf M. Circadian rhythm of serum cortisol in Cushing's disease. J Clin Endocrinol Metab 1984; 59: 161-165.

31. Refetoff S., Van Cauter E., Fang V.S., Laderman C., Graybeal M.L., Landau R.L. The effect of dexamethasone on the 24-hour profiles of adrenocorticotropin and cortisol in Cushing's syndrome. J Clin Endocrinol Metab 1985; 60: 527-535.

32. Putignano P., Toja P., Dubini A., Giraldi P.F., Corsello S.M., Cavaqnini F. Midnight salivary cortisol versus urinary free and midnight serum cortisol as screening tests for Cushing's syndrome. J Clin Endocrinol Metabol 2003; 88: 4153-4157.

33. Kahn J.P., Rubinov D.R., Davis C.L., Kling M., Post R.M. Salivary cortisol: a practical method for evaluation of adrenal function. Biol Psychiat 1988; 23: 335-349.

34. Guechot J., Fiet J., Passa P., Villette J.M., Gourmel B., Tabuteau F., Cathelineau G., Dreux C. Physiological and pathological variations in saliva cortisol. Hormone Res 1982; 16: 357-364.

35. Evans P.J., Peters J.R., Dyas J., Walker R.F., Riad-Fahmy D., Hall R. Salivary cortisol levels in true and apparent hypercortisolism. Clin Endocrinol (Oxford) 1984; 20: 709-715.

36. Raff H., Raff J.L., Finding J.W. Late-night salivary cortisol as a screening test for Cushing's syndrome. J Clin Endocrinol Metabol 1998; 83: 2681-2686.

37. Viardot A., Huber P., Puder J.J., Zulewski H., Keller U., Muller B. Reproducibility of Nighttime Salivary Cortisol and its use in the diagnosis of hypercortisolism compared with urinary free and overnight dexamethasone suppression test. J Clin Endocrinol Metabol 2005; 90: 5730-5736.

38. Deutschbein T., Unger N., Hinrichs J., Walz M.K., Mann K., Petersen S. Late-night and low-dose dexamethasone-supressed cortisol in saliva and serum for the diagnosis of cortisol-secreting adrenal adenoma. Eur J Endocrinol 2009; 161: 747-753.

39. Sakihara S, Kageyama K, Oki Y, Doi M, Iwasaki Y, Takayasu S, Moriyama T, Terui K, Nigawara T, Hirata Y, Hashimoto K, Suda T. Evaluation of plasma, salivary, and urinary cortisol levels for diagnosis of Cushing's syndrome. Endocrin J 2010; 57: 331-337. doi: 10.1507/endocrj.K09E-340

40. Baid S.K., Sinaii N., Wade M., Rubino D., Nieman L.K. Radioimmunoassay and tandem mass spectrometry measurement of bedtime salivary cortisol levels: a comparison of assays to establish hypercortisolism. J Clin Endocrinol Metabol 2007; 92: 3102-3107.

41. Alexandraki K.I., Grossman A.B. Novel insights in the diagnosis of Cushing's syndrome. Neuroendocrinology 2010; 92: Suppl 1: 35-43.

42. Beko G., Varga I., Glaz E., Sereg M., Feldman K., Toth M., Racz K., Patocs A. Cutoff values of midnight salivary cortisol for the diagnosis of overt hypercortisolism are highly influenced by methods. Clin Chim Acta 2010; 411: 364-367.

43. Raff H. Cushing's syndrome: diagnosis and surveillance using salivary cortisol. J Pituitary 2011.

44. Erickson D., Singh R.J., Sathananthan A., Vella A., Bryant S.C. Late-night salivary cortisol for diagnosis of Cushing's syndrome by liquid chromatography/tandem mass spectrometry assay. Clin Endocrinol (Oxford) 2011. Doi 10.1111/j. 1365-2265.2011.04239.x.

45. Гончаров Н.П., Кация Г.В., Марова Е.И., Колесникова Г.С., Арапова С.Д., Рожинская Л.Я. Использование ультрачувствительного метода определения биологически активного свободного кортизола в слюне для оценки глюкокортикоидной функции коры надпочеников. Пробл эндокринол 2008; 58: 3: 27-35.

46. Poll E.M., Kreitsschmann-Andermahr I., Langejuergen Y., Stanzel S., Gilsbach J.M., Gressner A., Yagmur E. Saliva collection method affects predictability of serum cortisol. Clin Chim Acta 2007; 382: 15-19.

47. Vogeser M., Durner J., Seliger E., Auernhammer C. Measurement of late-night salivary cortisol with an automated immunoassay system. Clin Chem Lab Med 2006; 44: 1441-1445.

48. Белая Ж.Е., Ильин А.В., Мельниченко Г.А., Рожинская Л.Я., Драгунова Н.В., Дзеранова Л.К., Огнева Н.А., Бутрова С.А., Трошина Е.А, Колесникова Г.С., Дедов И.И. Автоматизированный электрохемилюминисцентный метод определения кортизола в слюне для диагностики эндогенного гиперкортицизма среди пациентов с ожирением. Ожирение и метаболизм 2011; 27: 2: 56-63.

49. Jeyaraman K., Amini A.C., Nandita G., Dwivedi S.N. Late-night salivary cortisol in normal subjects and in patients with Cushing's syndrome. Postgraduate Med J 2010; 86: 399-404.

50. Carrozza C., Corsello S.M., Paragliola R.M., Palumbo F.I.S., Locantore P., Sferrazza A., Pontecorvi A., Zuppi C. Clinical accuracy of midnight salivary cortisol measured by automated electrochemiluminescence immunoassay method in Cushing's syndrome. Ann Clin Biochem 2010; 47: 228-232.

51. Sereg M., Toke J., Patocs A., Varga I., Igaz P., Szucs N., Horanyi J., Pusztai P., Czirjak S., Glaz E., Racz K., Toth M. Diagnostic performance of salivary cortisol and serum osteocalcin measurements in patients with overt and subclinical Cushing's syndrome. Steroids 2011; 76: 38-42.

52. Yaneva M., Kirilov G., Zacharieva S. Midnight salivary cortisol, measured by highly sensitive electrochemiluminescene immunoassay, for the diagnosis of Cushing's syndrome. Central Eur J Med 2009; 4: 59-64.

53. Chen Y.M., Cintron N.M., Whitson P.A. Long-term storage of salivary cortisol samples at room temperature. Clin Chem 1992; 38: 304.

54. Smith R.E., Maquire J.A., Stein-Oakley A.N., Sasano H., Takahashi K., Fukushima K., Krozowski Z.S. Localization of 11Β-hydroxisteroid dehydrogenase type II in human epithelial tissues. J. Clin Endocrinol Metab 1996; 81: 3244-3248.

55. Badrick E., Kirschbaum C., Kumari M. The relationship between smoking status and cortisol secretion. J Clin Endocrinol Metab 2007; 92: 819-824.

56. Kivlighan K.T., Granger D.A., Schwartz E.B., Nelson V., Curran M., Shirtcliff E.A. Quantifying blood leakage into the oral mucosa and its effects on the measurement of cortisol, dehydroepiandrosterone, and testosterone in saliva. Horm Behav 2004; 46: 39-46.


Для цитирования:


., ., ., . Современный взгляд на скрининг и диагностику эндогенного гиперкортицизма. Проблемы Эндокринологии. 2012;58(4):35-41. https://doi.org/10.14341/probl201258435-41

For citation:


Belaia Z.E., Rozhinskaia L.I., Mel'nichenko G.A., Dedov I.I. Current views of the screening and diagnostics of endogenous hypercorticism. Problems of Endocrinology. 2012;58(4):35-41. (In Russ.) https://doi.org/10.14341/probl201258435-41

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