scholarly journals Urine free cortisol analysis by automated immunoassay and high-performance liquid chromatography for the investigation of Cushing's syndrome: a comment on the paper of Ching et al.

2007 ◽  
Vol 44 (3) ◽  
pp. 316-316
Author(s):  
Martin Fenske
Keyword(s):  
High Performance Liquid Chromatography ◽  
Liquid Chromatography ◽  
Cushing’S Syndrome ◽  
High Performance ◽  
Cushing's Syndrome ◽  
Urine Free Cortisol ◽  
Free Cortisol ◽  
Automated Immunoassay

scholarly journals The role of high performance liquid chromatography in the functional state of the adrenal glands before and after surgical treatment for corticosteroma

2020 ◽  
Vol 11 (2) ◽  
pp. 30-37
Author(s):  
M. O. Buinova ◽  
N. V. Vorokhobina ◽  
L. I. Velikanova ◽  
E. G. Strelnikova ◽  
V. L. Baranov
Keyword(s):  
High Performance Liquid Chromatography ◽  
Liquid Chromatography ◽  
Adrenal Cortex ◽  
Cushing’S Syndrome ◽  
Postoperative Period ◽  
High Performance ◽  
Cushing's Syndrome ◽  
Early Postoperative Period ◽  
Cortisol Secretion ◽  
Autonomous Cortisol Secretion

Objective: It is to evaluate the functional state of the adrenal cortex after surgical treatment in patients with corticosteromas for optimize of tactic of postoperative management.Materials and methods: We examined 143 patients (43 men and 100 women) aged 51.3 ± 10.1 years with incidentaloma of adrenal glands and 27 healthy peopels (control group) aged 45.5 ± 5.7 years. Cushing's syndrome was detected in 22 patients, autonomous cortisol secretion was detected in 43. All patients had an analysis of the complaints, objective, laboratory and instrumental data in the preoperative and early postoperative periods. Assessment of levels glucocorticoid and mineralocorticoid hormones in biological fluids was carried out by immunoassay and high performance liquid chromatography.Results: The signs of adrenal cortex insufficiency in the early postoperative period were obtained in 77.3% of patients with Cushing's syndrome and in 25% of patients with autonomous cortisol secretion according to immunoassay and high performance liquid chromatography. An increase of level of corticosterone in the serum of blood in the preoperative period indicate the possibility development of adrenal insufficiency in the early postoperative period in all patients. Аn increase of levels of 11-deoxycortisol and 18-OH-corticosteronein in the serum of blood аnd urinary excretion of free cortisone, 18-OH-corticosterone and 6β-hydroxycortisol indicate the possibility development of adrenal insufficiency in the early postoperative period in patients with Cushing's syndrome.Conclusions: The determination of cortisol and aldosterone precursors by high performance liquid chromatography increases the accuracy of the diagnosis of glucocorticoid and mineralocorticoid function of the adrenal cortex in patients with Cushing's syndrome and with autonomous cortisol secretion in the early postoperative period.

scholarly journals SUN-LB34 A Case of BMAH With Aberrant Vasopressin Adrenal Receptors

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Faheem Seedat ◽  
Nazeer Ahmed Mohamed ◽  
Nereshni Lutchman
Keyword(s):  
Cushing’S Syndrome ◽  
Salivary Cortisol ◽  
Incidental Finding ◽  
Serum Cortisol ◽  
Cushing's Syndrome ◽  
Screening Tests ◽  
Pathological Examination ◽  
Unilateral Adrenalectomy ◽  
Urine Free Cortisol ◽  
Free Cortisol

Abstract We report on a 42 - year old woman was referred following an incidental finding of bilateral macronodular (nodules > 1cm) adrenal glands after a computed tomography scan for investigation of an unrelated urological problem. Clear features of Cushing’s syndrome were elicited on initial clincal evaluation and screening tests confirmed the diagnosis biochemically: midnight salivary cortisol 15.4nmol/L (0.2 - 3nmol/L), 24 hour urine free cortisol > 662.4nmol/L (8.3 - 118.7nmol/L per 24 hours) and an 8am serum cortisol measured 951nmol/L following 1mg dexamethasone suppression test (< 50nm/L). A serum adrenocorticotropic hormone (ACTH) measured 0.3pmol/L (1.6 - 13.9pmol/L) suggesting, in light of the CT findings, an adrenal source of the elevated cortisol. Screening for aberrant adrenal receptors to catecholamines, Gastric inhibitory peptide, ACTH, vasopressin and Gonadotropin releasing hormone was performed. A positive biochemical response to ACTH and vasopressin was noted as measured serum cortisol increased to 1600pmol/L (upper limit of the assay). Following a unilateral adrenalectomy, were pathological examination of the respected adrenal gland confirmed adrenal hyperplasia, the patient had both clinical and biochemical resolution of hypercortisolemia. 2 weeks following surgery her midnight salivary cortisol measured 2.1nmol/L (0.2 - 3nmol/L) and 24 hour urine free cortisol 218nmol/L (8.3 - 118.7nmol/L per 24 hours). Her 8am ACTH also increased to 2.9pmol/L (1.6 - 13.9pmol/L). Biochemical screening of her sister showed no evidence of Cushing’s syndrome. Bilateral macronodualr hyperplasia (BMAH) represents a rare cause of Cushing’s syndrome may be diagnosed incidentally and is often associated with an insidious onset. We use this case to highlight the complexities of provocative testing for aberrant adrenal receptors which occur with BMAH and the utilization of unilateral adrenalectomy to achieve clinical and biochemical remission of Cushing’s syndrome thus, removing the need for post - operative steroid replacement following bilateral adrenalectomy.

scholarly journals Neutrophil-Lymphocyte Ratio as an Initial Screening Biomarker for Differential Diagnosis of Cushing’s Syndrome from Nonfunctional Adenoma in Patients with an Adrenal Mass

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Wei Wang ◽  
Jianing Wang ◽  
Cheng Shen ◽  
Sainan Zhu ◽  
Ying Gao ◽  
...  
Keyword(s):  
Cushing’S Syndrome ◽  
Adrenal Mass ◽  
Serum Cortisol ◽  
Cushing's Syndrome ◽  
Initial Screening ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Late Night ◽  
Urine Free Cortisol ◽  
Free Cortisol

Objective. Assessing excess adrenal hormones is important in patients with adrenal mass. Current screening tests for excess cortisol hormones are complex, so it cannot be done sometimes due to the limited medical resources. The aim of the study was to evaluate whether the neutrophil-lymphocyte ratio (NLR) can be used as an initial screening biomarker for Cushing’s syndrome (CS) in patients with an adrenal mass. Methods. This retrospective study included a total of 185 patients with CS and 185 patients with nonfunctional adrenal adenoma (matched 1 : 1 by sex, body mass index, and discharge date). The NLR was compared between the two groups. The association between NLR and serum and urinary cortisol concentrations was analyzed, and an NLR cut-off value for CS screening was calculated. Results. NLR (3.38 (2.33, 5.45) vs. 2.13 (1.74, 3.00), P < 0.001 ) was significantly higher in the CS group than in the nonfunctional adenoma group. In CS patients, the NLR was positively associated with serum cortisol concentrations at 8 am, with 24-hour urine free cortisol and with serum cortisol after a 1 mg dexamethasone suppression test ( P < 0.001 each). An NLR cut-off of 2.2 had a sensitivity of 80.0% and a specificity of 54.05%. The weighted Youden index for the NLR was similar to that of the 24-hour urine free cortisol and late-night serum cortisol tests, which are recommended initial tests for CS diagnosis. Conclusion. The NLR may be useful for initial screening for CS among patients with an adrenal mass as an easy and convenient marker.

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