促发手术治疗对引起生化性皮质醇增多症的肾上腺意外瘤患者有益的代谢效应。
Beneficial metabolic effects of prompt surgical treatment in patients with an adrenal incidentaloma causing biochemical hypercortisolism.
机构信息
Department of Medical Sciences, University of Milan, 20122 Milan, Italy.
出版信息
J Clin Endocrinol Metab. 2010 Jun;95(6):2736-45. doi: 10.1210/jc.2009-2387. Epub 2010 Apr 7.
CONTEXT
In patients with adrenal incidentalomas, subclinical hypercortisolism (SH) is associated with an increased prevalence of the metabolic syndrome. The effect of surgical/conservative approach is debated.
OBJECTIVE
The objective of the study was to determine the effect of the surgical and conservative approaches on the metabolic syndrome in patients with adrenal incidentalomas.
DESIGN
This was a retrospective longitudinal study (18-48 months follow-up).
SETTING
The study was conducted on an in- and outpatient basis.
PATIENTS
One hundred eight patients with adrenal incidentalomas were studied for the presence of SH, which was diagnosed in the presence of more than two of the following: urinary free cortisol greater than 70 microg per 24 h (193 nmol per 24 h), cortisol after 1 mg dexamethasone suppression test greater than 3.0 microg/dl (83 nmol/liter), ACTH less than 10 pg/ml (2.2 pmol/liter).
INTERVENTIONS
Surgery was performed in 25 patients with SH (group TrSH+) and 30 without SH (group TrSH-), whereas the conservative approach was chosen by 16 patients with SH (group UntrSH+) and 37 without SH (group UntrSH-).
MAIN OUTCOME MEASURES
During the follow-up, the improvement/worsening of body weight, blood pressure, or glucose and cholesterol levels was defined in the presence of a greater than 5% weight decrease/increase and following the European Society of Cardiology or the Adult Treatment Panel III criteria, respectively.
RESULTS
In group TrSH+, weight, blood pressure, and glucose levels improved (32, 56, and 48%, respectively) more frequently than in group UntrSH+ (12.5%, P = 0.05; 0.0%, P < 0.0001; 0.0%, P = 0.001; and 0.0%, P = 0.0014, respectively). In group UntrSH+, blood pressure, glucose, and low-density lipoprotein levels worsened more frequently (50.0, 37.5, and 50.0%, respectively) than in group TrSH+ (0.0%, P < 0.0001; 0.0%, P = 0.001; and 20.0%, P = 0.05, respectively).
CONCLUSIONS
Regarding the various components of the metabolic syndrome, in patients with adrenal incidentalomas and SH, surgery is beneficial.
背景
在肾上腺意外瘤患者中，亚临床皮质醇增多症（SH）与代谢综合征的患病率增加有关。手术/保守治疗的效果存在争议。
目的
本研究旨在确定手术和保守治疗对肾上腺意外瘤患者代谢综合征的影响。
设计
这是一项回顾性纵向研究（18-48 个月的随访）。
地点
本研究在门诊和住院患者中进行。
患者
研究了 108 例肾上腺意外瘤患者，以确定是否存在 SH，SH 的诊断标准为存在以下两项或两项以上：24 小时尿游离皮质醇大于 70 mcg（193 nmol/24 h）、1 毫克地塞米松抑制试验后皮质醇大于 3.0 mcg/dl（83 nmol/L）、ACTH 小于 10 pg/ml（2.2 pmol/L）。
干预措施
对 25 例 SH 患者（TrSH+组）和 30 例无 SH 患者（TrSH-组）进行手术，对 16 例 SH 患者（UntrSH+组）和 37 例无 SH 患者（UntrSH-组）进行保守治疗。
主要观察指标
在随访期间，根据体重减轻或增加超过 5%，并根据欧洲心脏病学会或成人治疗专家组 III 标准，定义体重、血压或血糖和胆固醇水平的改善/恶化。
结果
在 TrSH+组中，体重、血压和血糖水平的改善更为常见（分别为 32%、56%和 48%），而在 UntrSH+组中则不常见（12.5%，P=0.05；0.0%，P<0.0001；0.0%，P=0.001；0.0%，P=0.0014，分别）。在 UntrSH+组中，血压、血糖和低密度脂蛋白水平的恶化更为常见（分别为 50.0%、37.5%和 50.0%），而在 TrSH+组中则不常见（0.0%，P<0.0001；0.0%，P=0.001；20.0%，P=0.05，分别）。
结论
对于肾上腺意外瘤和 SH 患者的代谢综合征各组成部分，手术是有益的。
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