Urinary Prostate-Specific Antigen is Elevated in Female Patients with Cushing's Syndrome.

Background: It has been demonstrated that the expression of prostate-specific antigen (PSA) is known to not be organ or gender specific but rather a steroid hormone mediated response, and the level of PSA is elevated in the serum of women with hyperandrogenic syndromes. The urinary profile of PSA in female subjects is less clear. We investigated the expression of urinary PSA in female subjects with Cushing's syndrome and the relationship between urinary PSA and 2 steroid hormonal metabolites, 17-hydroxycorticosteroids (17-OHCS) and 17-ketosteroids (17-KS).Methods: We classified 97 female patients into 1 of 3 groups: Group A (n=37), patients with Cushing's syndrome (n=30), or adrenocortical hyperplasia (n=7); Group B (n=29), patients with primary hyperaldosteronism (n=18) or pheochromocytoma (n=11); and Group C (n=31), patients with non-adrenal diseases, including hypertension (n=12) and Type 2 diabetes (n=19). Patients with Cushing's syndrome or primary hyperaldosteronism were defined by clinical symptoms and laboratory confirmation. Patients with pheochromocytoma were defined by clinical symptoms, laboratory confirmation, and computed tomography or MRI. Patients with non-adrenal diseases were defined by a serum cortisol and plasma adrenocorticotropic hormone (ACTH) level within normal limits. Patients taking any medications in this category were excluded. Biochemical indicators related to the steroid hormonal metabolism, such as 17-OHCS, 17-KS, PSA, and creatinine (Cre) of 24-hour urine in these subjects were measured. The 17-OHCS, 17-KS, and PSA were all adjusted for 24-hour urinary Cre. Results: The 24-hour urinary PSA levels were significantly higher (P<0.0001) in the female patients with Cushing's syndrome (mean ± SE=17.52 ± 2.10μg/mol Cre) than in the controls (mean ± SE=4.65 ± 1.23μg/mol Cre). Similarly, there was also a significant difference (P<0.01) between 24-hour urinary 17-KS of the female patients (mean ± SE=7.17 ± 0.59 mmol/mol Cre) and the controls (6.17 ± 0.55 mmol/mol Cre). A correlation was observed between 24-hour urinary PSA level and 24-hour urinary 17-KS concentration (rs=0.720, P<0.01). In Group A, the area under the curve (AUC) value of PSA (0.853, P<0.001) was greater than that of 17-OHCS (0.811, P<0.001) and 17-KS (0.693, P<0.01), respectively. In Group B, the AUC value of PSA (0.722, P<0.01) was greater than that of 17-OHCS (0.663, P>0.01) and 17-KS (0.632, P>0.01), respectively. Conclusions: Urinary PSA was elevated in female patients with Cushing's syndrome. It indicates that urinary PSA may be an additional parameter for a better definition of female patients suffering from Cushing's syndrome. [ABSTRACT FROM AUTHOR]

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