Androulakis Ioannis I, Kaltsas Gregory A, Markou Athina, Tseniklidi Ermioni, Kafritsa Paraskevi, Pappa Theodora, Papanastasiou Lambrini, Piaditis George P
Department of Endocrinology and Diabetes, General Hospital of Athens "G. Genimatas"Department of Pathophysiology, Endocrine Unit, Medical School, University of Athens, Athens, Greece.
Clin Endocrinol (Oxf). 2011 Jul;75(1):44-9. doi: 10.1111/j.1365-2265.2011.04013.x.
To investigate autonomous cortisol and aldosterone secretion and insulin resistance (IR) indices, in patients with incidentally discovered bilateral adrenal lesions (BA).
Thirty-six patients with BA, 113 patients with unilateral adrenal incidentalomas (UA) and 89 healthy subjects (C) with normal adrenal imaging.
All participants underwent adrenal imaging, baseline biochemical and hormonal measurements and the following investigations on consecutive days: (i) A 2-h oral glucose tolerance test (OGTT) (75 g) with glucose and insulin measurements every 30 min. (ii) An adrenocorticotrophin (ACTH) stimulation test with intravenous (i.v.) bolus administration of 250 μg of ACTH (1-24) and measurement of serum cortisol and aldosterone before and after 30 and 60 min. (iii) A low-dose dexamethasone suppression test (LDDST) (0·5 mg of dexamethasone every 6-h for 2 days) with cortisol measurement 6 h after the last dexamethasone dose and (iv) A NaCl (0·9%) postdexamethasone saline infusion test (PD-SIT) (2 l of NaCl 0·9% iv in 4 h) following the LDDST, with aldosterone measurement at the end of the test.
Cortisol and aldosterone cut-offs based on the mean + 2 SD values obtained from the C group following the LDDST and PD-SITs were calculated (34·11 nm and 74·83 pm, respectively). Based on the above cut-offs, autonomous cortisol and aldosterone secretion was found in 42·5 and 15·9% of patients with UA, and in 41·7 and 19·4% of patients with BA, respectively. In addition, 17·7% of patients with UA and 19·4% of patients with BA had concomitant autonomous cortisol and aldosterone secretion. Cortisol and aldosterone levels following the LDDST and PD-SIT were significantly higher in the BA compared to the UA group, respectively. Furthermore, patients with BA had more pronounced glucose levels and insulin resistance (IR) indices compared to patients with UA.
Patients with BA have more pronounced autonomous cortisol and aldosterone secretion and glucose metabolism alterations than patients with UA. Further studies are needed to evaluate the potential long-term consequences of these findings.
研究偶然发现的双侧肾上腺病变（BA）患者的自主皮质醇和醛固酮分泌以及胰岛素抵抗（IR）指标。
36例BA患者、113例单侧肾上腺偶发瘤（UA）患者和89例肾上腺影像正常的健康受试者（C）。
所有参与者均接受肾上腺成像、基线生化和激素测量，并在连续几天进行以下检查：（i）2小时口服葡萄糖耐量试验（OGTT）（75g），每30分钟测量一次血糖和胰岛素。（ii）静脉推注250μg促肾上腺皮质激素（ACTH）（1-24）进行促肾上腺皮质激素刺激试验，分别在30分钟和60分钟前后测量血清皮质醇和醛固酮。（iii）小剂量地塞米松抑制试验（LDDST）（每6小时服用0.5mg地塞米松，共2天），在最后一剂地塞米松后6小时测量皮质醇，以及（iv）在LDDST后进行地塞米松后生理盐水输注试验（PD-SIT）（4小时内静脉输注2L 0.9%氯化钠），试验结束时测量醛固酮。
根据LDDST和PD-SIT后C组获得的均值+2标准差计算皮质醇和醛固酮的临界值（分别为34.11nmol/L和74.83pmol/L）。根据上述临界值，分别在42.5%的UA患者和41.7%的BA患者中发现自主皮质醇分泌，在15.9%的UA患者和19.4%的BA患者中发现自主醛固酮分泌。此外，17.7%的UA患者和19.4%的BA患者同时存在自主皮质醇和醛固酮分泌。与UA组相比，BA组LDDST和PD-SIT后的皮质醇和醛固酮水平分别显著更高。此外，与UA患者相比，BA患者的血糖水平和胰岛素抵抗（IR）指标更明显。
与UA患者相比，BA患者的自主皮质醇和醛固酮分泌以及糖代谢改变更明显。需要进一步研究来评估这些发现的潜在长期后果。
