山东医药2024，Vol.64Issue(14)：1-5,5.DOI:10.3969/j.issn.1002-266X.2024.14.001
肾上腺腺瘤型亚临床库欣综合征患者腺瘤切除术后肾上腺皮质功能减退影响因素及其预测效能
Influencing factors for adrenal insufficiency after adrenalectomy in patients with adrenal adenoma-type subclinical Cushing's syndrome and their predictive efficiency
摘要
Abstract
Objective To explore the influencing factors for adrenal insufficiency after adrenalectomy in patients with adrenal adenoma-type subclinical Cushing's syndrome(SCS)and to analyze the predictive efficacy of relevant influ-encing factors on postoperative adrenal insufficiency.Methods Fifty-nine patients with adrenal adenoma-type SCS un-derwent laparoscopic unilateral adrenalectomy.Adrenal insufficiency was assessed one month postoperatively based on se-rum cortisol levels.Preoperative general data[gender,age,body mass index(BMI),blood pressure,metabolic comorbid-ities(overweight/obesity,hypertension,abnormal glucose metabolism,dyslipidemia,osteopenia/osteoporosis),tumor di-ameter],preoperative adrenal function-related hormone levels[adrenocorticotropic hormone(ACTH)and cortisol diurnal rhythm(8:00,24:00),cortisol after 1 mg dexamethasone suppression test(1 mg-DST),cortisol after low-dose dexameth-asone suppression test(LDDST),serum dehydroepiandrosterone sulfate(DHEAS),and 24-hour urine free cortisol(UFC)],and postoperative glucocorticoid use were compared between patients with adrenal insufficiency and those with normal adrenal function.We constructed a binary Logistic regression analysis model using indicators with intergroup com-parison of P<0.10,analyzed the influencing factors of postoperative adrenal insufficiency in patients with SCS,and evalu-ated the predictive efficacy of relevant indicators by the receiver operating characteristic(ROC)curve.Results Adrenal insufficiency was observed in 25 out of 59 patients with SCS one month after surgery,accounting for 42.37%of these cas-es.Compared with patients with normal adrenal function,patients with adrenal insufficiency had decreased plasma ACTH levels at 8:00,and increased serum cortisol levels at 24:00 and after 1 mg-DST before surgery.Logistic regression analy-sis showed that preoperative serum cortisol after 1 mg-DST was an independent influencing factor for the development of ad-renal insufficiency in patients with SCS postoperatively.The relative risk ratio of adrenal insufficiency after surgery in SCS patients with preoperative 1 mg-DST serum cortisol≥233 nmol/L was 13.698(95%CI:2.965-63.274).Conclusions Patients with SCS are at risk of developing adrenal insufficiency after surgery.Preoperative serum cortisol after 1 mg-DST is an independent influencing factor for postoperative adrenal insufficiency and has good predictive efficacy on the occur-rence of adrenal insufficiency after surgery.关键词
肾上腺腺瘤/亚临床库欣综合征/肾上腺腺瘤切除术后并发症/肾上腺皮质功能减退Key words
adrenal adenoma/subclinical Cushing's syndrome/complications after adrenalectomy/adrenal insuf-ficiency分类
医药卫生引用本文复制引用
田朝阳,刘梦思,楼媛,曾阳杰,王怡洁,崇立业,李平..肾上腺腺瘤型亚临床库欣综合征患者腺瘤切除术后肾上腺皮质功能减退影响因素及其预测效能[J].山东医药,2024,64(14):1-5,5.基金项目
国家重点研发计划(2022YFC2505300,2022YFC2505306). （2022YFC2505300,2022YFC2505306）
