Indicaciones e interpretación de los estudios analíticos hormonales de la corteza suprarrenal

Résumé

In the adrenal cortex, entities ranging from benign diseases such as adrenocortical adenomas to malignant diseases such as adrenocortical carcinoma or adrenal metastases can be found. Regarding functionality, the spectrum of diseases varies widely: from non-functioning adenomas, patients with autonomous cortisol secretion (ACS), primary hyperaldosteronism (PHA), ACTH-independent Cushing's syndrome, excess secretion of sex hormones, congenital adrenal hyperplasia (CAH), and adrenal insufficiency (AI). A hormonal study is essential for the proper characterization of these disorders. Baseline hormonal tests and functional studies are both necessary in some cases to reach the definitive diagnosis. The test of choice for Cushing's syndrome screening is urinary free cortisol, late-night salivary cortisol, or a 1 mg dexamethasone suppression test (DST). For ACS, it is a DST. For PAH, it is calculation of the plasma aldosterone concentration and renin activity or concentration ratio. For AI, it is the determination of plasma cortisol between 8:00 and 9:00 a.m. and after cosyntropin stimulation. Lastly, for CAH, it is the measurement of plasma 17-hydroxyprogesterone.