中国实用内科杂志2024，Vol.44Issue(2)：134-139,6.DOI:10.19538/j.nk2024020109
良性肾上腺源性库欣综合征临床特点比较分析
Comparison and analysis of clinical features of benign adrenal Cushing syndrome
摘要
Abstract
Objective To provide a clinical basis for differential diagnosis,clinical features of Adrenocortical adenoma(ADA),bilateral macronodular adrenal hyperplasia(BMAH)and primary pigmented nodular adrenocortical disease(PPNAD)with overt Cushing syndrome were compared.Methods The clinical data of inpatients with confirmed ADA(n=86),BMAH(n=23)and PPNAD(n=7)were analyzed retrospectively from 2008 to 2020 in Chinese PLA General Hospital.Results 1.Patients in BMAH were the oldest with the average age(51.7±9.5)years,and patients in PPNAD group were the youngest with the average age of(19.9±5.7)years.There were more female patients in ADA and PPNAD groups,whereas the proportion of males to females in BMAH group was approximately equal.2.Clinical presentation:Purple striae(71.4％)were more common in PPNAD group,but there were no statistically differences in the presence of facial plethora,easy bruising,moon face,central obesity,and skin thinning among the three groups.3.Metabolic complications:Hyperglycemia and lipid disorders in the BMAH group were more common(87.0％and 68.2％,respectively),and the percentage of low bone mass or osteoporosis were all high in the three groups(＞75％).Systolic pressure,Glycated hemoglobin A1c,triglyceride,and serum sodium were higher in BMAH group(P＜0.05),compared with other two groups.In addition,all three groups presented marked insulin resistance according to HOMA-IR.4.ACTH and cortisol(F)levels:The baseline ACTH levels of the three groups were inhibited,and serum F and 24 h UFC levels increased in all three groups(P＞0.05).In patients with PPNAD,the 24 h UFC levels significantly elevated after low-dose dexamethasone suppression test(LDDST)and high-dose dexamethasone suppression test(HDDST)(all P＜0.05),compared with baseline 24 h UFC levels.Conclusion In benign overt adrenal Cushing syndrome,patients with BMAH are older and have more metabolic disorders,whereas patients with PPNAD are younger.The elevated 24 h UFC levels after LDDST and HDDST are useful for identifying PPNAD.关键词
库欣综合征/非ACTH依赖/皮质腺瘤/双侧肾上腺大结节增生/原发性色素性结节样肾上腺皮质疾病Key words
Cushing syndrome/ACTH-independent/adrenocortical adenoma/bilateral macronodular adrenal hyperplasia/primary pigmented nodular adrenocortical disease分类
医药卫生引用本文复制引用
苗新宇,杜锦,郭清华,王先令,臧丽,李一君,闫文华,李春霖,母义明,林璐,李乐乐,窦京涛,陈康,吕朝晖,巴建明,裴育,谷伟军..良性肾上腺源性库欣综合征临床特点比较分析[J].中国实用内科杂志,2024,44(2):134-139,6.基金项目
国家重点研发计划(2020YFC2004902) （2020YFC2004902）
北京市海淀区卫生健康发展科研培育计划(HP2021-03-80303) （HP2021-03-80303）
