Akademik Veri Yönetim Sistemi
Steroids, cilt.233-234, 2026 (SCI-Expanded, Scopus)
Background: Autonomous cortisol secretion (ACS) is the most common hormonal dysfunction in adrenal incidentalomas and is associated with increased cardiometabolic morbidity. Dehydroepiandrosterone sulfate (DHEAS), an ACTH-dependent adrenal steroid, may decrease in ACS due to hypothalamic–pituitary–adrenal axis suppression. This study evaluated the diagnostic utility of DHEAS and DHEAS-based ratios, particularly within a dexamethasone suppression test (DST)-integrated framework, for differentiating ACS from non-functioning adrenal adenomas (NFA). Methods: In this retrospective single-center study, records of 433 patients followed for adrenal incidentaloma between 2015 and 2021 were reviewed. After applying predefined criteria, 67 patients were included: 35 with ACS and 32 with NFA. ACS was defined using a post–1 mg DST cortisol threshold of ≥ 1.8 µg/dL and confirmed with a two-day low-dose DST. Clinical, metabolic, biochemical, hormonal, and radiological parameters were analyzed. ROC analyses and logistic regression were performed, and internal validation was conducted using bootstrapping with 1,000 iterations. Results: Comorbidities were more frequent in ACS. ACTH, DHEAS, DHEAS/cortisol ratio, DHEAS/1-mg DST cortisol ratio, and TyG index differed significantly between groups. Post–1 mg DST cortisol showed the highest discriminatory performance (AUC = 0.967). Although DHEAS alone had limited diagnostic utility, the DHEAS/1-mg DST cortisol ratio showed good discrimination (AUC = 0.884, 95% CI: 0.802–0.966) and remained the only independent predictor of ACS (OR: 0.931, 95% CI: 0.895–0.968, p < 0.001). TyG showed moderate discrimination but was not an independent predictor. Conclusion: The DHEAS/1-mg DST cortisol ratio may serve as a useful adjunctive marker for ACS–NFA differentiation, especially in borderline or ambiguous cases, but requires prospective external validation.