Endocrine Unit, 2nd Department of Internal Medicine-Propaedeutic, Research Institute and Diabetes Center, Athens University Medical School, Attikon University Hospital, Athens 12462, Greece.
Metabolism. 2010 Oct;59(10):1435-41. doi: 10.1016/j.metabol.2010.01.007. Epub 2010 Feb 13.
The objective of the study was to assess insulin resistance (IR) and metabolic syndrome (MS) in patients with nonfunctioning adrenal incidentalomas (NFAIs). Among a total cohort of 46 patients with adrenal incidentalomas, we studied 29 patients with NFAIs (mean age, 54 ± 9 years; body mass index, 29 ± 3 kg/m(2)) and 37 age-, sex-, and body mass index-matched healthy controls. Besides the endocrine workup, IR was evaluated using fasting glucose and insulin concentrations, homeostasis model assessment of IR, and quantitative insulin sensitivity check index. In a subgroup of patients undergoing an oral glucose tolerance test, Matsuda index and total area under the curve for glucose and insulin were also evaluated. Total cholesterol, high-density lipoprotein, low-density lipoprotein, triglycerides, and other biochemical parameters were measured with standard techniques. Body composition was determined with dual-energy x-ray absorptiometry. Patients with NFAIs exhibited higher fasting glucose, insulin, and homeostasis model assessment of IR values; decreased quantitative insulin sensitivity check index and Matsuda index; and an increased-although not statistically significant-area under the curve for glucose and insulin compared with controls (P < .05). In addition, they exhibited higher systolic and diastolic blood pressure, triglycerides, and γ-glutamyltransferase and lower high-density lipoprotein cholesterol levels compared with controls (P < .05). Patients with NFAIs were all obese with a central type of fat accumulation and increased appendicular lean mass. Indices of IR showed a positive correlation with indices of MS (P < .05), but no correlation with markers of hormonal activity. Nonfunctioning adrenal incidentalomas are characterized by IR, hypertension, dyslipidemia, and fatty liver disease, all of them being components of MS. Thus, patients with NFAIs should be screened for MS during their initial workup to identify those at cardiometabolic risk and implement the appropriate interventions.
本研究旨在评估无功能性肾上腺偶然瘤（NFAIs）患者的胰岛素抵抗（IR）和代谢综合征（MS）。在总共 46 例肾上腺偶然瘤患者中，我们研究了 29 例 NFAIs 患者（平均年龄 54 ± 9 岁；体重指数 29 ± 3 kg/m(2)）和 37 例年龄、性别和体重指数匹配的健康对照者。除了内分泌检查外，还使用空腹血糖和胰岛素浓度、稳态模型评估的胰岛素抵抗和定量胰岛素敏感性检查指数来评估 IR。在进行口服葡萄糖耐量试验的患者亚组中，还评估了 Matsuda 指数和葡萄糖及胰岛素的总曲线下面积。采用标准技术测量总胆固醇、高密度脂蛋白、低密度脂蛋白、甘油三酯和其他生化参数。采用双能 X 射线吸收法测定身体成分。与对照组相比，NFAIs 患者的空腹血糖、胰岛素和稳态模型评估的胰岛素抵抗值更高；定量胰岛素敏感性检查指数和 Matsuda 指数较低；尽管葡萄糖和胰岛素的曲线下面积增加，但无统计学意义（P <.05）。此外，与对照组相比，NFAIs 患者的收缩压和舒张压、甘油三酯和γ-谷氨酰转移酶水平较高，而高密度脂蛋白胆固醇水平较低（P <.05）。NFAIs 患者均肥胖，存在中心性脂肪堆积和四肢瘦体重增加。IR 指数与 MS 指数呈正相关（P <.05），但与激素活性标志物无关。无功能性肾上腺偶然瘤的特点是 IR、高血压、血脂异常和脂肪肝疾病，所有这些都是 MS 的组成部分。因此，NFAIs 患者在初次检查时应筛查 MS，以确定处于心血管代谢风险的患者，并实施适当的干预措施。
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