Сombination of classical tests and high performance liquid chromatography for glucocorticoids determination in the subclinical Cushing’s syndrome diagnostics

Abstract

Analysis of biological fluids steroid profiling, obtained by combination of high performance liquid chromatography with classical tests in 151 patients with adrenal incidentalomas, is presented in this article. Subclinical Cushing’s syndrome is diagnosed by the combination of following criteria: urinary excretion of free cortisol and free cortisone more than the lowest value of reference range after 2 mg dexamethasone suppression test with the blood cortisol level more than 90 nmol/l after

1 mg dexamethasone suppression test. Increased rаtio of corticosterone/11-dehydrocorticosteron and urinary free cortisol/ urinary free cortisone as well as decreased ratio of 6β-hydroxycortisol/ urinary free cortisol obtained in patients with subclinical Cushing’s syndrome , might be used as an additional diagnostic criteria of this disease. The investigation of steroid profiles in biological liquids by high performance liquid chromatography for patients suffer from the adrenal incidentaloma has a great significance when blood cortisol level after the dexamethasone suppression test lays in the range from 50 to 90 nmol/l, which can be called as «the grey zone». The combination of subclinical symptoms of Cushing’s syndrome, obtained by classical samples and high performance liquid chromatography improves sensitivity and improves the diagnosis of disease.

Keywords

high-performance liquid chromatography / adrenal incidentaloma / subclinical Cushing’s sydndrome / obesity / free urinary cortisol / free saliva cortisol / 1mg and 2 mg dexamethasone suppression tests / intermediate products of steroidogenesis

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