【作者】 何琴；

【导师】 邓华聪；

【作者基本信息】 重庆医科大学 ， 内科学， 2016， 硕士

【摘要】 随着影像技术的发展,肾上腺意外瘤(adrenal incidentaloma,AI)的发病率越来越高。AI即是指因非肾上腺疾病行影像学检查,而偶然发现的肾上腺占位性病变。根据其是否具有内分泌功能可以分为:无功能腺瘤(non-functioning adenomas,NA)、亚临床库欣综合征(Subclinical Cushing’s syndrome,SCS)、嗜铬细胞瘤(Pheochromocytoma,PHEO)、原发性醛固酮增多症(Primary hyperaldosteronism,PHA)等;根据其良恶性可以分为:肾上腺皮质腺癌、肾上腺转移癌等。一但发现则需详细询问病史、仔细进行体格检查,并结合影像学及激素水平评估,明确其良恶性及是否具有内分泌功能,从而选择治疗策略、进行围手术期处理,并指导随访,从而提高远期生存率。多项研究表明,AI中最为常见的内分泌综合征即SCS。因SCS缺乏典型的库欣综合征(Cushing’s syndrome,CS)临床表现,常被临床医务工作者漏诊和误诊。然而,此综合征存在轻度内源性皮质醇分泌增多,可导致糖脂代谢异常、骨质疏松,增加椎骨骨折及心血管事件的发生率,并能对其他系统产生影响。SCS现已成为内分泌领域新近的研究焦点并且目前尚缺乏诊断金标准及明确的治疗方案。本综述主要就SCS的诊断、并发症以及治疗进行阐述,旨在引起医务工作者对该疾病的重视。更多还原

【Abstract】 The morbidity incidence of adrenal incidentaloma is increasingly increased in the wake of imaging technology development. Adrenal incidentaloma(AI) is a term, which is an accidentally discovered adrenal mass on imaging examination for unadrenal diseases. It can be categorized into non-functioning adenomas(NA), Subclinical Cushing’s syndrome(SCS), Pheochromocytoma(PHEO), Primary hyperaldosteronism(PHA) and so on according to its secretory function, and can be categorized into primary adrenocortical carcinoma, metastatic cancer and so on according to the pathologic type of the tumor. Once AI is find, it is necessary to identify its pathologic type and whether it has secretory function by entire medical history, careful physical examination and hormone and radiologic evaluation, which would help us select the optimal treatment, perioperative management and develop the plan of follow-up to improve the long-term survival rate. Many studies have indicated that SCS is the most common endocrinic syndrome of AI. It has no typical clinical manifestations so that it is often misdiagnosed or missed diagnosis. However, due to the increased secretion of endogenous glucocorticoids caused by this syndrome, SCS is closely associated with glucose and lipid metabolism disorder, osteoporosis, vertebral fractures, cardiovascular disease and so on. In recent years, SCS has become a popular research topic in endocrinology, and there is no gold standard of diagnosis and preferred treatment prescription until now. This review summarized and expounded the diagnosis, complications and therapies of SCS, which arouses medical workers attention to SCS and making patients get early diagnosis and early treatment.更多还原