{"doi":"10.1210/clinem/dgae468","title":"Steroid Profiling and Circadian Cortisol Secretion in Patients With Mild Autonomous Cortisol Secretion: A Cross-sectional Study","abstract":"CONTEXT: Mild autonomous cortisol secretion (MACS) is diagnosed based on postdexamethasone cortisol >1.8 µg/dL. Scarce evidence exists on steroid circadian secretion and steroid metabolome in MACS. OBJECTIVE: To characterize 24-hour (h) urine steroid metabolome in patients with MACS and determine circadian differences in urine steroid profiling and cortisol concentrations in patients with MACS vs referent subjects. METHODS: Cross-sectional study, 2018-2023, at a referral center. Patients with MACS and age-, sex-, body mass index-, and menopausal status-matched referent subjects were included. Urine was collected over a 24 hour period as separate daytime and nighttime collections. High-resolution mass spectrometry assay was used to measure 25 steroids. A subgroup of patients and referent subjects was admitted for serum measurements of free and total cortisol every 2 hours. Outcomes were steroids, steroid sums, and ratios. RESULTS: Patients with MACS (n = 72) had lower µg/24 hour median androgens (2084 vs 3283, P < .001), higher glucocorticoids (15 754 vs 12936, P < .001), and higher glucocorticoid/androgen ratio (8.7 vs 3.9, P < .001) than referent subjects. Patients also had lower steroid day/night ratios than referent subjects, reflecting a higher relative nocturnal steroid production in MACS. In a subgroup of 12 patients with MACS and 10 referent subjects, the 24-hour areas under the curve for total and free serum cortisol were similar. However, evening mean total (5.3 vs 4.0 µg/dL, P = .056) and free (0.2 vs 0.1 µg/dL, P = .035) cortisol was higher in patients vs referent subjects. CONCLUSION: Patients with MACS demonstrate an abnormal urine steroid metabolome, with a high glucocorticoid to androgen ratio, and a higher nocturnal steroid production.","journal":"The Journal of Clinical Endocrinology & Metabolism","year":2024,"id":426522,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":17,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9351,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":467964,"name":"Sumitabh Singh","orcid":"0000-0001-6203-6955","position":1,"is_corresponding":false},{"id":311948,"name":"Andreas Ebbehøj","orcid":"0000-0001-7104-7824","position":2,"is_corresponding":false},{"id":686625,"name":"Catherine D Zhang","orcid":"0000-0003-2784-2673","position":3,"is_corresponding":false},{"id":1039619,"name":"Rohit Nathani","orcid":null,"position":4,"is_corresponding":false},{"id":1225902,"name":"Vanessa Fell","orcid":"0000-0003-4583-8694","position":5,"is_corresponding":false},{"id":97274,"name":"Elizabeth J. Atkinson","orcid":"0000-0002-1191-3775","position":6,"is_corresponding":false},{"id":300279,"name":"Sara J. Achenbach","orcid":null,"position":7,"is_corresponding":false},{"id":1226546,"name":"Ann L Rivard","orcid":null,"position":8,"is_corresponding":false},{"id":264539,"name":"Ravinder Singh","orcid":"0009-0001-6484-1365","position":9,"is_corresponding":false},{"id":554734,"name":"Stefan K. Grebe","orcid":"0000-0003-1736-3206","position":10,"is_corresponding":false},{"id":239586,"name":"Irina Bancos","orcid":"0000-0001-9332-2524","position":11,"is_corresponding":false},{"id":1039017,"name":"Jasmine Saini","orcid":"0000-0001-7156-6229","position":0,"is_corresponding":true}],"reference_count":43,"raw_metadata":null,"created_at":"2026-07-19T01:58:42.796720Z","pmid":"38981002","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}