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Edo N, Morita K, Ishiwata C, Nakajima R, Sayama Y, Suzuki T, Sakamoto M, Okamoto K, Uchino T, Ozawa Y, Uno K, Uno K, Tsukamoto K, Ishikawa T. Diagnostic value of standard deviation score of log-transformed serum dehydroepiandrosterone sulfate in patients with hypothalamic-pituitary-adrenal axis insufficiency. Endocr J 2021; 68:1337-1345. [PMID: 34162776 DOI: 10.1507/endocrj.ej21-0140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Serum dehydroepiandrosterone sulfate (DHEA-S) levels reflect the state of adrenocorticotropic hormone (ACTH) secretion. However, it is difficult to use serum DHEA-S to diagnose hypothalamic-pituitary-adrenal (HPA) axis insufficiency due to its non-normal and highly skewed distribution. In this study, we focused on HPA insufficiency caused by hypothalamic and/or pituitary dysfunction and evaluated the usefulness of the standard deviation score of log-transformed DHEA-S (ln DHEA-S SD score), which was calculated from the established age- and sex-specific reference values. We retrospectively reviewed the medical records of 94 patients suspected of having HPA insufficiency, in whom serum DHEA-S measurement and the rapid ACTH stimulation test were performed, and included 65 patients who met our criteria in this study. The ln DHEA-S SD scores were distributed more normally than measured DHEA-S levels and were significantly higher in patients with a peak cortisol level ≥18 μg/dL than in those below this value, suggesting that this score is a legitimate and strong indicator of adrenocortical function. The optimal cut-off value for impaired HPA function was -0.853, with a sensitivity of 70.3% and a specificity of 100%. Among the 37 patients whose peak cortisol levels were below 18 μg/dL, 11 patients with ln DHEA-S scores ≥-0.853 exhibited significantly higher basal ACTH and basal and peak cortisol levels than the 26 patients with scores <-0.853. Thus, this score plays a supportive role in evaluating HPA axis function, particularly in patients with borderline cortisol responses to ACTH.
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Affiliation(s)
- Naoki Edo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo 173-8605, Japan
- Department of Clinical Research Medicine, Teikyo University School of Medicine, Tokyo 173-8605, Japan
| | - Koji Morita
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo 173-8605, Japan
| | - Chisato Ishiwata
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo 173-8605, Japan
| | - Rina Nakajima
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo 173-8605, Japan
| | - Yohei Sayama
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo 173-8605, Japan
| | - Takashi Suzuki
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo 173-8605, Japan
| | - Miki Sakamoto
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo 173-8605, Japan
| | - Kaori Okamoto
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo 173-8605, Japan
| | - Takuya Uchino
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo 173-8605, Japan
| | - Yuki Ozawa
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Shin-Kuki General Hospital, Saitama 346-0021, Japan
| | - Kiyoko Uno
- Teikyo Academic Research Center, Teikyo University, Tokyo 173-8605, Japan
| | - Kenji Uno
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo 173-8605, Japan
| | - Kazuhisa Tsukamoto
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo 173-8605, Japan
| | - Toshio Ishikawa
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo 173-8605, Japan
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