Department of Endocrinology, Athens' Polyclinic Hospital, Athens, Greece.
Endocrine. 2011 Dec;40(3):437-44. doi: 10.1007/s12020-011-9490-1. Epub 2011 May 20.
Aberrant receptors have been implicated in the pathogenesis of several types of adrenal tumours. So far the presence of aberrant receptors has been investigated in patients with massively enlarged adrenals due to ACTH-independent macronodular adrenal hyperplasia (AIMAH) and unilateral adrenal adenomas associated with overt or subclinical Cushing's syndrome. The likelihood of aberrant responses in patients presenting with bilateral adrenal incidentalomas (BI) presenting as discrete solitary bilateral adenomas has not been thoroughly addressed. This is an observational cross-sectional prospective study conducted in a secondary/tertiary care centre. We studied 33 patients; 28 with incidentally discovered bilateral discrete adrenal adenomas and five with massive bilateral adrenal macronodular hyperplasia. We probed responses to physiological stimuli, namely upright posture and meal; in a subgroup of menopausal women the presence of aberrant gonadotropin receptors was assessed by the LHRH test. Abnormal responses obtained in tests performed with no dexamethasone suppression were always repeated and confirmed under dexamethasone suppression. Aberrant cortisol responses were confirmed in 10 patients; 9 to posture, 1 to meal (along with a positive response to posture) and 1 to LHRH tests. Patients who responded to any test compared to those who tested negative had larger adenomas, higher post-LDDST and midnight cortisol and a trend for lower ACTH levels. Patients without subclinical hypercortisolism (SH) did not respond to any test while 50% of patients with SH had an aberrant response (P = 0.002). A greater prevalence of aberrant responses was noted in patients with bilateral macronodular hyperplasia compared to those with solitary bilateral adenomas (80 vs. 21.4%, P = 0.02). Aberrant cortisol responses, primarily to posture testing, are present in a substantial proportion of patients with bilateral adrenal incidentalomas. Such cortisol responses are observed only in patients with subclinical hypercortisolism and especially in those patients with larger adrenal lesions.
异常受体与几种肾上腺肿瘤的发病机制有关。到目前为止，已经在因促肾上腺皮质激素非依赖性大结节性肾上腺增生（AIMAH）导致肾上腺大量增大的患者以及与显性或亚临床库欣综合征相关的单侧肾上腺腺瘤患者中研究了异常受体的存在情况。双侧肾上腺偶发瘤（BI）表现为离散的孤立双侧腺瘤患者出现异常反应的可能性尚未得到充分探讨。这是一项在二级/三级护理中心进行的观察性横断面前瞻性研究。我们研究了33例患者；28例为偶然发现的双侧离散肾上腺腺瘤，5例为双侧肾上腺大结节性增生。我们探究了对生理刺激的反应，即直立姿势和进食；在一组绝经后女性亚组中，通过促性腺激素释放激素（LHRH）试验评估异常促性腺激素受体的存在情况。在未使用地塞米松抑制的试验中获得的异常反应总是在使用地塞米松抑制的情况下重复并得到证实。10例患者被证实存在异常皮质醇反应；9例对姿势有反应，1例对进食有反应（同时对姿势有阳性反应），1例对LHRH试验有反应。与检测结果为阴性的患者相比，对任何试验有反应的患者腺瘤更大，地塞米松抑制试验后（LDDST）及午夜皮质醇水平更高，促肾上腺皮质激素（ACTH）水平有降低趋势。无亚临床皮质醇增多症（SH）的患者对任何试验均无反应，而50%的SH患者有异常反应（P = 0.002）。与孤立双侧腺瘤患者相比，双侧大结节性增生患者中异常反应的患病率更高（80%对21.4%，P = 0.02）。相当一部分双侧肾上腺偶发瘤患者存在异常皮质醇反应，主要是对姿势试验的反应。这种皮质醇反应仅在亚临床皮质醇增多症患者中观察到，尤其是在肾上腺病变较大的患者中。
