亚临床及肾上腺腺瘤型库欣患者的糖代谢紊乱

目的评价亚临床和肾上腺腺瘤型库欣患者糖代谢紊乱状况。方法对32例亚临床库欣(组1)、33例典型的肾上腺腺瘤型库欣(组2)及40例无功能瘤患者(组3)分别行口服糖耐量试验(OGTT),计算胰岛素敏感指数(ISI)、HOMA指数(HOMA-IR)、葡萄糖及胰岛素曲线下面积(AUCg,AUCi);同时检测各组患者血和尿皮质醇、血促肾上腺皮质激素(ACTH)及血钾等指标。以58名健康体检者作为对照组(组4)。结果组1、组2、组3和组4糖代谢紊乱的患病率分别为46.9%、48.5%、27.5%和22.4%;组2患者糖代谢相关指标,如空腹及糖负荷2 h后血糖(FBG及2 h PBG)、空腹及糖负荷2 h后血胰岛素(FIN及2 hPIN)及根据OGTT结果计算的AUCg、AUCi及HOMA-IR均高于其他组,而ISI则低于其他组别;剔除性别、年龄、腰围等相关因素的影响,多元回归分析结果显示,FBG、2 h PBG、AUCi与血、尿皮质醇水平呈正相关。组1患者皮质醇分泌仅为轻度升高,尚不足以引起库欣综合征典型的临床表现,但糖代谢紊乱和糖尿病的患病率亦升高(15.6%),其FBG、2 h PBG及AUCi等与血、尿皮质醇水平亦相关。结论亚临床及肾上腺腺瘤型库欣患者糖代谢紊乱的患病率明显升高,可能与皮质醇的高分泌状态有关。目的评价亚临床和肾上腺腺瘤型库欣患者糖代谢紊乱状况。方法对32例亚临床库欣(组1)、33例典型的肾上腺腺瘤型库欣(组2)及40例无功能瘤患者(组3)分别行口服糖耐量试验(OGTT),计算胰岛素敏感指数(ISI)、HOMA指数(HOMA-IR)、葡萄糖及胰岛素曲线下面积(AUCg,AUCi);同时检测各组患者血和尿皮质醇、血促肾上腺皮质激素(ACTH)及血钾等指标。以58名健康体检者作为对照组(组4)。结果组1、组2、组3和组4糖代谢紊乱的患病率分别为46.9%、48.5%、27.5%和22.4%;组2患者糖代谢相关指标,如空腹及糖负荷2 h后血糖(FBG及2 h PBG)、空腹及糖负荷2 h后血胰岛素(FIN及2 hPIN)及根据OGTT结果计算的AUCg、AUCi及HOMA-IR均高于其他组,而ISI则低于其他组别;剔除性别、年龄、腰围等相关因素的影响,多元回归分析结果显示,FBG、2 h PBG、AUCi与血、尿皮质醇水平呈正相关。组1患者皮质醇分泌仅为轻度升高,尚不足以引起库欣综合征典型的临床表现,但糖代谢紊乱和糖尿病的患病率亦升高(15.6%),其FBG、2 h PBG及AUCi等与血、尿皮质醇水平亦相关。结论亚临床及肾上腺腺瘤型库欣患者糖代谢紊乱的患病率明显升高,可能与皮质醇的高分泌状态有关。

Disturbance of glucose metabolism in subclinical Cushing's syndrome due to adrenal incidentaloma and Cushing's syndrome with adrenal adenoma

Objective To look for some features of glucose metabolism disturbance in patients with subclinical Cushing's syndrome(SCS) and Cushing's syndrome with adrenal adenoma. Methods Thirty-two cases of SCS(Group 1) and 33 of Cushing's syndrome with adrenal adenoma(Group 2) were evaluated.All of them were measured plasma cortisol at 8:00 and 24:00,24 h urinary free cortisol,plasma potassium,8:00 plasma adrenocorticotropic hormone(ACTH) and underwent oral glucose tolerance test(OGTT) to calculate insulin index(ISI),insulin resistance index(HOMA IR),area under the curve of glucose(AUCG) and insulin(AUCI).The results were compared with 40 patients of nonfunctional adrenal adenoma(NAA,Group 3) and 58 healthy controls(Group 4). ResultsAs defined by WHO,the prevalence of glucose metabolism disturbance was 46.9%,48.5%,27.5% and 22.4% in the four groups,respectively.In group 2,the fasting and 2 h postprandial plasma glucose,fasting and 2h postprandial plasma insulin,AUCG and AUCI,and HOMA IR were higher than those of the other three groups,but the ISI was lower.Rejecting the influence of sex,age and waist circumference,the fast blood glucose(FBG),2 h postprandial blood glucose(PBG) and AUCI were correlated with levels of plasma and urinary cortisol.Even if the amount of cortisol excess it was insufficient to give a clear Cushing phenotype,but it induced elevation of prevalence of glucose metabolism disturbance or diabete mellitus.The measurements of glucose metabolism were also correlated with levels of plasma and urinary cortisol. Conclusion Our study indicates that patients with SCS and Cushing's syndrome with adrenal adenoma have a significantly high prevalence of glucose metabolism disturbance.It is related to over secretion of glucocorticoid.