Tsuiki Mika, Tanabe Akiyo, Takagi Sachiko, Naruse Mitsuhide, Takano Kazue
Department of Medicine, Clinical Institute of Endocrinology, Tokyo Women's Medical University,Japan.
Endocr J. 2008 Aug;55(4):737-45. doi: 10.1507/endocrj.k07e-177. Epub 2008 May 28.
Although subclinical Cushing's syndrome has been commonly experienced, details of the clinical outcome and its indication for adrenalectomy have yet to be established. In the present study, we investigated the prevalence of cardiovascular risks, their clinical outcome during long-term follow up before and after adrenalectomy in 20 patients with subclinical Cushing's syndrome. We also correlated the hypercortisolism and age with the cardiovascular risks and the clinical outcome. The prevalence of hypertension, impaired glucose metabolism, dyslipidemia, and obesity was 45%, 65%, 65%, and 25%, respectively. In the non-operated group (n = 12), six patients (50%) showed deterioration of at least one of the cardiovascular risks. Four patients showed an increase of at least one risk, while none of the patients showed a decrease in the number of risks. One patient developed overt Cushing's syndrome. In the operated group (n = 10) including two operated patients of the non-operated group, eight patients (80%) showed an improvement of at least one of the cardiovascular risks after surgery and five patients (50%) showed a decrease of at least one risk. The prognosis in terms of the changes of the cardiovascular risks was significantly better in the operated group than in the non-operated group (p<0.001). Neither the hypercortisolism nor age correlated to the presence and the clinical outcome of the cardiovascular risks. The present study clearly demonstrated probability of deterioration during the clinical course and improvement after adrenal surgery in patients with subclinical Cushing's syndrome. Careful follow-up of the cardiovascular risks is therefore warranted. Adrenalectomy could be a treatment of choice despite the hypercortisolism and age of the patients, especially when the cardiovascular risks show signs of deterioration.
尽管亚临床库欣综合征较为常见，但临床结局的细节及其肾上腺切除术的指征尚未明确。在本研究中，我们调查了20例亚临床库欣综合征患者心血管风险的患病率、肾上腺切除术前和术后长期随访期间的临床结局。我们还将高皮质醇血症和年龄与心血管风险及临床结局进行了关联分析。高血压、糖代谢受损、血脂异常和肥胖的患病率分别为45%、65%、65%和25%。在未手术组（n = 12）中，6例患者（50%）至少有一项心血管风险恶化。4例患者至少有一项风险增加，而没有患者的风险数量减少。1例患者发展为显性库欣综合征。在手术组（n = 10）中，包括2例从未手术组中转来的患者，8例患者（80%）术后至少有一项心血管风险得到改善，5例患者（50%）至少有一项风险降低。手术组心血管风险变化方面的预后明显优于未手术组（p<0.001）。高皮质醇血症和年龄均与心血管风险的存在及临床结局无关。本研究清楚地表明，亚临床库欣综合征患者在临床过程中存在恶化的可能性，而肾上腺手术后情况会改善。因此，有必要对心血管风险进行仔细随访。尽管患者存在高皮质醇血症和年龄因素，但肾上腺切除术仍可能是一种治疗选择，尤其是当心血管风险出现恶化迹象时。
