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Objective By comparison of the urinary free cortisol (UFC) levels in post- to prior-dexamethasone suppression test (post UFC/pre UFC) with primary pigmented nodular adrenocortical disease (PPNAD), primary bilateral macronodular adrenal hyperplasia (PBMAH) and adrenocortical adenoma (ADA), to explore the optimal differential diagnostic cut-off point of PPNAD from PBMAH and ADA. Methods The clinical data were collected and retrospectively analyzed of in patients admitted from January 2008 to December 2020 with finally diagnosed as PPNAD (n=7), PBMAH (n=31) and ADA (n=130) in the First Medical Center of Chinese PLA General Hospital. Based on the receiver operating characteristic (ROC) curve, the value of post UFC/pre UFC in low-dose dexamethasone suppression test (LDDST) and high-dose dexamethasone suppression test (HDDST)was used as the detection variable, and the diagnosis of PPNAD was used as the status variable to search the best cut-off point for the differential diagnosis of PPNAD. Results The serum cortisol (F) levels of all the 3 groups of patients (PPNAD, PBMAH and ADA) increased significantly in the baseline, LDDST and HDDST, and no statistical difference existed among them (P>0.05). The adrenocorticotropic hormone (ACTH) levels in all the 3 groups of patients were inhibited, and ACTH levels in PBMAH group were the highest at the baseline and after HDDST, and the ACTH levels of ADA group were the lowest among the three groups (P<0.05).The baseline 24 h UFC levels elevated obviously with no statistical difference (P>0.05) among the three groups. For patients in PPNAD group, the LDDST post UFC/pre UFC [1.88(1.39, 2.59)] was obviously higher than that in PBMAH group [1.13(0.82,1.37), P=0.001] and ADA group [1.11(0.70, 1.49), P=0.003]; and the HDDST post UFC/pre UFC in PPNAD group [2.31(1.23,3.08)] was still higher than that in PBMAH group [1.22(0.94, 1.63), P=0.004] and ADA group [1.39(1.08, 1.53), P=0.008].Compared with PBMAH group and ADA group, the diagnostic cut-off point for PPNAD group after LDDST post UFC/pre UFC was 1.385, with 85.7% sensitivity and 71.5% specificity; and after HDDST post UFC/pre UFC was 2.290, with 57.1% sensitivity and 95.0% specificity. Conclusion The cut-off points of post UFC/pre UFC in DST had a clear advantage in distinguishing PPNAD from PBMAH and ADA. The diagnosis of PPNAD may be considered once the value of post UFC/pre UFC after LDDST is greater than 1.385, or after HDDST is above 2.290.
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| 科 Family | 属数 Number of genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) | 属 Genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) |
|---|---|---|---|---|---|---|
| 鹅膏菌科Amanitaceae | 2 | 11 | 5.26 | 鹅膏菌属 Amanita | 10 | 4.78 |
| 小菇科 Mycenaceae | 2 | 12 | 5.74 | 丝盖伞属 Inocybe | 5 | 2.39 |
| 多孔菌科 Polyporaceae | 8 | 14 | 6.70 | 蜡蘑属 Laccaria | 5 | 2.39 |
| 红菇科 Russulaceae | 3 | 23 | 11.00 | 小皮伞属 Marasmius | 6 | 2.87 |
| 小菇属 Mycena | 11 | 5.26 | ||||
| 光柄菇属 Pluteus | 5 | 2.39 | ||||
| 红菇属 Russula | 17 | 8.13 | ||||
| 栓菌属 Trametes | 5 | 2.39 |
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