Department of Endocrinology, Athens Polyclinic Hospital, Athens, Greece.
Clin Endocrinol (Oxf). 2011 Apr;74(4):438-44. doi: 10.1111/j.1365-2265.2010.03963.x.
The prevalence of subclinical hypercortisolism (SH) in unilateral incidentalomas (UI) has been extensively studied; however, patients with bilateral incidentalomas (BI) have not been thoroughly investigated. We therefore aimed to describe the characteristics of patients with BI compared to their unilateral counterparts. The surgical outcome in a small number of patients is reported.
Observational retrospective study in a single secondary/tertiary centre.
One hundred and seventy-two patients with adrenal incidentalomas (41 with BI).
Morning cortisol (F), ACTH, dehydroepiandrosterone sulphate (DHEA-S), midnight F, 24-h urine collection for cortisol (UFC), low-dose dexamethasone suppression test (LDDST), fasting glucose, insulin, and oral glucose tolerance test (OGTT). Primarily, SH was defined as F-post-LDDST>70 nmol/l and one more abnormality; several diverse cut-offs were also examined.
No difference was noted in age, body mass index, or prevalence of diabetes and impaired glucose tolerance between patients with UI and those with BI. Patients with BI had higher F-post-LDDST (119·3 ± 112·8 vs 54·3 ± 71·5 nmol/l, P<0·001) and lower DHEA-S (1·6 ± 1·5 vs 2·5 ± 2·3 μmol/l, P=0·003) but similar UFC, ACTH and midnight F levels, compared to UI. SH was significantly more prevalent in BI (41·5%vs 12·2%, P<0·001). Fourteen patients were operated on; four underwent bilateral interventions. In 10 patients, unilateral adrenalectomy on the side of the largest lesion resulted in significant improvement in F-post-LDDST (P=0·008) and a decrease in midnight F (P=0·015) levels.
Subclinical hypercortisolism is significantly more prevalent in bilateral incidentaloma patients, posing great dilemmas for its optimum management.
亚临床皮质醇增多症（SH）在单侧偶发瘤（UI）中的患病率已得到广泛研究；然而，双侧偶发瘤（BI）患者尚未得到充分研究。因此，我们旨在描述 BI 患者与单侧患者相比的特征。报告了少数患者的手术结果。
在单一的二级/三级中心进行的观察性回顾性研究。
172 名肾上腺偶发瘤患者（41 名 BI）。
清晨皮质醇（F）、ACTH、硫酸脱氢表雄酮（DHEA-S）、午夜 F、24 小时尿皮质醇（UFC）收集、小剂量地塞米松抑制试验（LDDST）、空腹血糖、胰岛素和口服葡萄糖耐量试验（OGTT）。主要将 SH 定义为 F 后-LDDST>70nmol/l 和一项以上异常；还检查了几种不同的截止值。
UI 患者和 BI 患者在年龄、体重指数或糖尿病和糖耐量受损的患病率方面无差异。BI 患者的 F 后-LDDST 更高（119.3±112.8 与 54.3±71.5 nmol/l，P<0.001），DHEA-S 更低（1.6±1.5 与 2.5±2.3 μmol/l，P=0.003），但 UFC、ACTH 和午夜 F 水平相似。与 UI 相比，BI 中 SH 的患病率明显更高（41.5%与 12.2%，P<0.001）。14 名患者接受了手术；4 名患者接受了双侧干预。在 10 名患者中，对最大病变侧的单侧肾上腺切除术导致 F 后-LDDST 显著改善（P=0.008）和午夜 F 水平降低（P=0.015）。
亚临床皮质醇增多症在双侧偶发瘤患者中明显更为普遍，这对其最佳管理提出了巨大的难题。
