肾上腺意外瘤中亚临床库欣综合征临床研究

目的探讨肾上腺意外瘤中亚临床库欣综合征的临床及危害性。方法2000~2005年对上海交通大学医学院附属瑞金医院的23例亚临床库欣综合征患者进行血糖、血脂、血尿皮质醇、血皮质醇昼夜节律、地塞米松抑制试验检测和观察,并与同期25例肾上腺腺瘤型库欣综合征患者的结果比较。结果(1)亚临床库欣综合征组年龄大于肾上腺腺瘤型库欣综合征组,两组肥胖、高血压、糖代谢异常及高血脂的发生率比较差异无显著性意义,两组体重指数(BMI)、腰臀比、血压、血脂、血糖及胰岛素比较差异均无显著性意义。(2)亚临床库欣综合征组血皮质醇、日平均血皮质醇、夜间皮质醇占清晨分泌量百分比及24h尿游离皮质醇均低于肾上腺腺瘤型库欣综合征组,2mg地塞米松抑制试验后血皮质醇及尿游离皮质醇亦低,两组晨8h血促肾上腺皮质激素(ACTH)比较差异无统计学意义。结论亚临床库欣综合征患者可导致肥胖、高血压、高血脂及糖代谢异常的发生,对患者造成一定的危害,且危害程度与肾上腺腺瘤型库欣综合征相近。

Clinical study of subclinical Cushing''''s syndrome in adrenal incidentaloma

Objective The purpose of the study was to evaluate the clinical and biochemical characteristics in subclinical Cushing's syndrome(SCS)in adrenal incidentaloma.Methods Twenty-three patients of SCS were evaluated in Ruijin Hospital,Affiliated to Shanghai Jiaotong University Medical College from 2000 to 2005.All of them were measured blood pressure,triglyceride(TG),total cholesterol(TC),LDL cholesterol,HDL cholesterol,plasma cortisol,urinary free cortisol,ACTH and underwent oral glucose tolerance test(OGTT).The results were compared with 25 patients of adrenal Cushing's syndrome.Results (1)The patients of SCS were older than those of adrenal Cushing's syndrome.There was no difference in prevalence of obese,hypertension,diabete mellitus,IGT and hyperlipidemia in two groups.There were also no differences in BMI,the waist to hip ratio(WHR),blood pressure,triglyceride(TG),total cholesterol(TC),LDL cholesterol,HDL cholesterol and the glucose or insulin in OGTT.(2)The patients of adrenal Cushing's syndrome had higher 8 h and 24 h plasma cortisol,daily average cortisol,cortisol at 24 h/8 h percent ratio,plasma and urinary cortisol after 2 mg dexamethasone suppression test(2 mg DST).There was no difference in 8 h plasma ACTH in two groups.Conclusion Even if the amount of cortisol excess is insufficient to give a clear Cushing phenotype,but it may induce some features of the metabolic syndrome,such as obesity,diabetes mellitus,impaired glucose tolerance,hypertension,and hyperlipid.Therefore,a careful biochemical and hormonal examination is advisable in patients with adrenal incidentaloma at first presentation.And if diagnosed as SCS,they need to be treated immediately.