Objective: To evaluate the function of serum dehydroepiandrosterone sulfate (DHEAS) in adult adrenal space-occupying lesions. Methods: In this cross-sectional study, 395 patients with adrenal space-occupying lesions who had their DHEAS levels measured were collected from the First Medical Center of Chinese PLA General Hospital from January 2010 to June 2021. They were divided into the adrenal Cushing syndrome (ACS) group (n=100) and non-ACS group (n=295). The former was divided into the cortisol-producing adrenal adenoma (CPA) group (n=67) and primary bilateral macronodular adrenal hyperplasia (PBMAH) group (n=33). Clinical data of each group were collected and compared among groups by independent samples t-test, chi-square test, and Mann-Whitney U test. Serum DHEAS ratio corrected for age and sex was further constructed to identify the receiver operating characteristic curve and the optimal tangent point value for different adrenal occupation. Results: Patients in the ACS group were younger (44.9±13.7 vs. 49.9±12.5, P=0.001); had a larger proportion of women (79/100 vs.139/295, P=0.001); and had higher cortisol levels [8∶00Am, 497.31 (343.52, 606.50) vs. 353.11 (267.50, 487.91) nmol/L, P<0.001] than those in the non-ACS group. The serum DHEAS level and ratio in the ACS group were significantly lower than those in the non-ACS group [0.50 (0.40, 1.21) vs. 2.68 (1.56, 4.32) μmol/L, 1.00 (0.43, 1.68) vs. 3.17 (2.21, 4.54), both P<0.001]. When the serum DHEAS ratio cut-off point was 1.29, the sensitivity and specificity for differential diagnosis of ACS and non-ACS were 72.0% and 91.5% respectively. The ratio of DHEAS in the CPA group was lower [0.58 (0.27, 1.05) vs. 1.14 (1.04, 2.40), P<0.001] than that in the PBMAH group. When the serum DHEAS ratio cut-off point was 0.99, the sensitivity and specificity for differential diagnosis of CPA and PBMAH were 64.2% and 81.2% respectively. Conclusion: Corrected age-sex DHEAS ratio can assist in the functional assessment of adrenal space-occupying lesions.
目的： 评价血清硫酸脱氢表雄酮（DHEAS）在成人肾上腺占位性病变功能评估中的价值。 方法： 横断面研究。收集解放军总医院第一医学中心自2010年1月至2021年6月测定DHEAS的肾上腺占位性病变患者395例，分组为肾上腺库欣综合征（ACS）组（100例）与非ACS组（295例）；前者进一步分为肾上腺皮质醇腺瘤（CPA）组（67例）与原发性双侧肾上腺大结节样增生（PBMAH）组（33例）。收集各组临床资料，采用独立样本t检验、χ2检验、Mann-Whitney U检验进行组间比较。进一步构建校正年龄、性别的血清DHEAS比值鉴别不同肾上腺占位性病变的受试者工作特征曲线及最佳切点值。 结果： 与非ACS组相比，ACS组年龄更小［（44.9±13.7）岁比（49.9±12.5）岁，P=0.001］，女性更多（79/100比139/295，P=0.001），皮质醇更高［8∶00Am 497.31（343.52，606.50）nmol/L比353.11（267.50，487.91）nmol/L，P<0.001］。ACS组患者血清DHEAS水平及比值均明显低于非ACS组［0.50（0.40，1.21）μmol/L比2.68（1.56，4.32）μmol/L，1.00（0.43，1.68）比3.17（2.21，4.54），均P<0.001］。血清DHEAS比值切点值为1.29时，鉴别ACS与非ACS的敏感度为72.0%，特异度为91.5%。与PBMAH组比较，CPA组DHEAS比值更低［0.58（0. 27，1.05）比1.14（1.04，2.40），P<0.001］。血清DHEAS比值切点值为0.99时，鉴别CPA与PBMAH的敏感度为64.2%，特异度为81.2%。 结论： 校正年龄及性别的DHEAS比值可协助肾上腺占位性病变的功能评估。.