Department of Clinical and Molecular Endocrinology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.
Hypertens Res. 2011 Oct;34(10):1111-5. doi: 10.1038/hr.2011.90. Epub 2011 Jul 21.
Subclinical Cushing's syndrome (SCS), a subtle cortisol hypersecretion from an adrenal tumor, may be a common adrenal disease. However, the cardiovascular prognosis and the optimal surgical and conservative treatment in SCS remain elusive. The present study was undertaken to evaluate the prevalence of cardiovascular risk factors in 16 SCS cases, their relationships to cortisol secretory activities, and the clinical outcome after surgical and medical treatment. The prevalence of hypertension, impaired glucose tolerance (IGT), diabetes mellitus (DM), dyslipidemia and obesity in our SCS cases were 56%, 50%, 50%, and 19%, respectively, and 75% of cases were associated with two or more cardiovascular risk factors. In our series, 24-h urinary free-cortisol excretion showed a significant positive correlation with HbA1c and a negative correlation with high-density lipoprotein-cholesterol, but no correlation with age, body mass index, blood pressure or glycemic and lipid profile was found. Eight cases underwent unilateral adrenalectomy (operated (OP) group); the remaining eight cases were a conservative-treatment group (non-OP group). The number of cardiovascular risk factors decreased significantly in the OP group, but not in the non-OP group. In terms of differential changes in risk factors between the groups, more significant improvements of hypertension, dyslipidemia and IGT/DM were observed in the OP group than in the non-OP group. In conclusion, the present study showed the increased prevalence of cardiovascular risk factors in SCS patients with mild hypercortisolism related to impaired glucose/lipid metabolism. Adrenalectomy decreased accumulated cardiovascular risk factors in certain SCS patients, suggesting the possible involvement of mild hypercortisolism in the development of cardiovascular risk factors in SCS.
亚临床库欣综合征（SCS）是一种由肾上腺肿瘤引起的皮质醇轻度过度分泌的微妙疾病，可能是一种常见的肾上腺疾病。然而，SCS 的心血管预后以及最佳的手术和保守治疗方法仍不清楚。本研究旨在评估 16 例 SCS 患者的心血管危险因素患病率、它们与皮质醇分泌活动的关系，以及手术和药物治疗后的临床转归。我们的 SCS 病例中高血压、葡萄糖耐量受损（IGT）、糖尿病（DM）、血脂异常和肥胖的患病率分别为 56%、50%、50%和 19%，75%的病例伴有两种或两种以上心血管危险因素。在我们的系列中，24 小时尿游离皮质醇排泄与 HbA1c 呈显著正相关，与高密度脂蛋白胆固醇呈负相关，但与年龄、体重指数、血压或血糖和血脂谱无关。8 例患者接受了单侧肾上腺切除术（手术组（OP））；其余 8 例患者为保守治疗组（非手术组（non-OP））。OP 组的心血管危险因素数量显著减少，但 non-OP 组没有。就两组之间危险因素的差异变化而言，OP 组的高血压、血脂异常和 IGT/DM 的改善更为显著。总之，本研究表明，轻度高皮质醇症相关的糖脂代谢受损的 SCS 患者心血管危险因素的患病率增加。肾上腺切除术降低了某些 SCS 患者累积的心血管危险因素，表明轻度高皮质醇症可能参与了 SCS 患者心血管危险因素的发生。
