库欣综合征的诊断：临床实践的回顾性评估。

Department of Endocrinology, Grenoble University Hospital, France.

Eur J Intern Med. 2006 Aug;17(5):334-8. doi: 10.1016/j.ejim.2006.02.006.

BACKGROUND

The aim of this study was to evaluate the efficiency of the clinical diagnosis of Cushing's syndrome (CS).

METHODS

A retrospective study was conducted of 72 consecutive patients with CS who, from 1995 to 2002, had been referred to the endocrinology department of a University Hospital by either endocrinologists or non-endocrinologists. Symptoms, signs, and biochemical screening tests used for confirmation of the diagnosis were recorded. Symptoms that led patients to a consultation were defined as reasons for consultation and were distinguished from other symptoms identified only by the referring physician.

RESULTS

Fifty-one patients requested a consultation for reasons related to CS, predominantly weight gain (44%) and muscle weakness (21%). In contrast, 21 patients did not request a consultation for symptoms related to CS. Assessment of physical signs demonstrated that the clinical presentation of patients was similar in both groups. However, endocrinologists referred significantly more patients who had not expressed symptoms related to CS than non-endocrinologists (38% vs. 17%, p<0.05). Appropriate screening tests (overnight 1-mg dexamethasone suppression test and/or urinary free cortisol) were used in all patients referred by endocrinologists and in 45% of patients referred by non-endocrinologists.

CONCLUSION

Our data show that many patients with CS do not spontaneously request a consultation for symptoms related to their condition. These patients are mostly identified by endocrinologists, who seem to have a better knowledge of physical signs and screening tests. Because endocrinologists are highly dependent upon non-endocrinologists for the recruitment of their patients, an improvement in the educational program is needed at the non-endocrinologist level. Our results may be of help in drafting the lines of this improvement by stressing the importance of the most specific physical signs and the most relevant screening tests for CS.

背景

本研究旨在评估库欣综合征（CS）临床诊断的效率。

方法

对 1995 年至 2002 年间因内分泌或非内分泌医生转诊至大学医院内分泌科的 72 例连续 CS 患者进行回顾性研究。记录用于确诊的症状、体征和生化筛查试验。导致患者就诊的症状被定义为就诊原因，并与仅由转诊医生识别的其他症状区分开来。

结果

51 例患者因与 CS 相关的原因就诊，主要是体重增加（44%）和肌肉无力（21%）。相比之下，21 例患者并未因与 CS 相关的症状就诊。体格检查评估表明，两组患者的临床表现相似。然而，与非内分泌医生相比，内分泌医生转诊的未表达与 CS 相关症状的患者明显更多（38%对 17%，p<0.05）。所有由内分泌医生转诊的患者和 45%的非内分泌医生转诊的患者均使用了适当的筛查试验（过夜 1mg 地塞米松抑制试验和/或尿游离皮质醇）。

结论

我们的数据表明，许多 CS 患者不会自发因与疾病相关的症状就诊。这些患者主要由内分泌医生发现，他们似乎对体征和筛查试验有更好的了解。由于内分泌医生高度依赖非内分泌医生招募其患者，因此需要在非内分泌医生层面改进教育计划。我们的研究结果可能有助于在制定改进方案时提供帮助，强调 CS 最特异性的体征和最相关的筛查试验的重要性。