【摘要】 目的比较肾上腺意外瘤中亚临床库欣综合征与肾上腺无功能瘤的临床及生化特征。方法在18例亚临床库欣综合征与24例肾上腺无功能瘤患者中进行血尿皮质醇、血皮质醇昼夜节律、地塞米松抑制试验,与30例健康对照者比较,并对所有患者进行定期随访。结果(1)亚临床库欣综合征组均匀性肥胖、高血压、糖尿病、高血脂的患病率均高于肾上腺无功能瘤组;(2)亚临床库欣综合征患者8:00血皮质醇、日平均血皮质醇、24:00血皮质醇/8:00血皮醇及24h尿游离皮质醇均高于其余两组,而8:00血ACTH则低,2mg地塞米松抑制试验血尿皮质醇抑制情况也较差;(3)亚临床库欣综合征组中有1例(5.56%)发展为临床显性库欣综合征,其余患者随访中生化指标与入组时测定结果比较无明显变化,2例肾上腺无功能瘤患者随访过程中肿瘤增大。结论部分肾上腺意外瘤患者伴有代谢综合征的表现,尤其在亚临床库欣综合征患者中更为多见;亚临床库欣综合征患者的生化改变较肾上腺无功能瘤患者及对照组明显,后两组生化测值比较无差别;亚临床库欣综合征患者有部分可发展成为临床显性库欣综合征。更多还原

【Abstract】 Objective To compare the clinical and biochemical characteristics in subclinical Cushing′s syndrome (SCS) and nonfunctional adrenal tumors of adrenal incidentalomas. Methods Eighteen patients of SCS and 24 patients of nonfunctional adrenal tumors underwent abdominal CT and assays of plasma cortisol, urinary free cortisol and dexamethasone suppression test, compared with 30 healthy controls. The patients were reevaluated at regular intervals. Results (1) The prevalence of metabolic syndrome, such as diffuse obesity, hypertension, diabetes and hyperlipidemia in SCS was higher than that in nonfunctional adrenal tumors. (2) The patients of SCS had higher serum and urinary cortisol values, higher 24:00 blood cortisol/8:00 blood corticol, lower ACTH concentration and impaired cortisol suppression by 2mg dexamethasone than the others. (3) During the follow-up, one of the SCS patients developed into overt Cushing′s syndrome. The others had no significant clinical or hormonal changes. Tumor size increased in 2 patients with nonfunctional adrenal tumors. Conclusion Some patients with adrenal incidentalomas have symptoms of metabolic syndrome, especially in SCS. The biochemical changes of SCS are more evident. There is no difference between nonfunctional adrenal tumors and controls. Some of patients with SCS may develop into overt Cushing′s syndrome.更多还原