Mitchell Ian C, Auchus Richard J, Juneja Kavita, Chang Alice Y, Holt Shelby A, Snyder William H, Nwariaku Fiemu E
Division of Gastrointestinal and Endocrine Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390-9156, USA.
Surgery. 2007 Dec;142(6):900-5; discussion 905.e1. doi: 10.1016/j.surg.2007.10.001.
A subgroup of patients with adrenal cortisol hypersecretion fails to meet the biochemical criteria for Cushing's syndrome. Appropriate therapy for this entity, subclinical Cushing's syndrome (subclinical CS), is unclear. We examined outcomes for patients who underwent unilateral adrenalectomy for subclinical CS.
Between 2003 and 2006, all patients who underwent adrenalectomy for cortisol hypersecretion caused by an adrenal mass were examined. We analyzed biochemical, metabolic, and clinical outcomes.
Overall, 24 patients underwent adrenalectomy for adrenal cortisol hypersecretion, of which 9 were found to have subclinical CS. Median serum cortisol was 2.0 microg/dL (range, 1.1-6.1) after 1-mg overnight dexamethasone suppression testing. Suspicious clinical findings on preoperative examination included skin bruising, unexplained weight gain, proximal muscle weakness, abnormal fat pads, skin thinning, fatigue, and facial plethora. During a median follow-up period of 5 months (range, 1-30 months), all 8 patients with easy bruising noted resolution postoperatively. Fatigue improved in 4 of 5 patients, muscle weakness in 6 of 8 patients, and weight in 7 of 9 patients, with a median body mass index change of -2.0 kg/m(2) (range, -7.1 to +0.5 kg/m(2)).
Adrenalectomy improves clinical and metabolic parameters for many patients with subclinical CS.
一部分肾上腺皮质醇分泌过多的患者不符合库欣综合征的生化标准。对于这种亚临床库欣综合征（亚临床CS）的合适治疗方法尚不清楚。我们研究了因亚临床CS接受单侧肾上腺切除术患者的治疗结果。
在2003年至2006年期间，对所有因肾上腺肿块导致皮质醇分泌过多而接受肾上腺切除术的患者进行了检查。我们分析了生化、代谢和临床结果。
总体而言，24例患者因肾上腺皮质醇分泌过多接受了肾上腺切除术，其中9例被发现患有亚临床CS。1毫克过夜地塞米松抑制试验后，血清皮质醇中位数为2.0微克/分升（范围为1.1 - 6.1）。术前检查中可疑的临床发现包括皮肤瘀斑、不明原因的体重增加、近端肌无力、异常脂肪垫、皮肤变薄、疲劳和面部充血。在中位随访期5个月（范围为1 - 30个月）内，所有8例有易瘀斑的患者术后瘀斑均消退。5例患者中有4例疲劳改善，8例患者中有6例肌无力改善，9例患者中有7例体重改善，体重指数中位数变化为-2.0千克/米²（范围为-7.1至+0.5千克/米²）。
肾上腺切除术改善了许多亚临床CS患者的临床和代谢参数。
