Oki K, Yamane K, Nakanishi S, Shiwa T, Kohno N
Department of Molecular and Internal Medicine, Graduate School of Biomedical Sciences, Hiroshima University, Japan.
Exp Clin Endocrinol Diabetes. 2012 Apr;120(4):244-7. doi: 10.1055/s-0032-1301896. Epub 2012 Feb 10.
The purpose of our study was to clarify whether subtle cortisol-producing tumors, such as not only subclinical Cushing's syndrome (SubCS) but also subclinical hypercortisolism (SH), influence the prevalence of hypertension, since numerous basic research studies have noted that glucocorticoid excess influences blood pressure.
80 patients with adrenocortical adenomas (39 women and 41 men; mean age 62.1 years) were enrolled. SubCS was diagnosed using a diagnostic criteria, and SH was diagnosed as the presence of a serum cortisol level greater than 50 nmol/L following 1-mg dexamethasone suppression test (DST).
SubCS, SH, or non-functioning adrenocortical adenoma (NF) was diagnosed in 14, 13, or 53 patients, respectively. The prevalence of hypertension differed significantly among the diagnoses (SubCS, 78.6%; SH, 84.6%; NF, 39.6%; P=0.002), whereas no differences in other clinical characteristics such as age, sex, or waist girth were observed. The patients with SH had an 11.7-fold increased risk (95% confidence interval: 1.9-72.7, P=0.009) and those with SubCS had a 9.5-fold increased risk (95% confidence interval: 1.9-48.3, P=0.007) for hypertension compared to those with NF using a multivariate analysis.
We demonstrated that subtle cortisol-producing tumors, such as SH as well as SubCS, were an independent risk factor for hypertension. The cut-off value of the 1-mg DST would be appropriate to predict the development of hypertension.
我们研究的目的是阐明微小的产生皮质醇的肿瘤，如不仅是亚临床库欣综合征（SubCS），还有亚临床皮质醇增多症（SH），是否会影响高血压的患病率，因为众多基础研究已指出糖皮质激素过量会影响血压。
纳入80例肾上腺皮质腺瘤患者（39例女性和41例男性；平均年龄62.1岁）。采用诊断标准诊断SubCS，将1毫克地塞米松抑制试验（DST）后血清皮质醇水平大于50 nmol/L诊断为SH。
分别在14例、13例和53例患者中诊断出SubCS、SH或无功能肾上腺皮质腺瘤（NF）。不同诊断组的高血压患病率差异显著（SubCS，78.6%；SH，84.6%；NF，39.6%；P = 0.002），而在年龄、性别或腰围等其他临床特征方面未观察到差异。与NF组相比，多因素分析显示SH组患高血压的风险增加11.7倍（95%置信区间：1.9 - 72.7，P = 0.009），SubCS组患高血压的风险增加9.5倍（95%置信区间：1.9 - 48.3，P = 0.007）。
我们证明了微小的产生皮质醇的肿瘤，如SH以及SubCS，是高血压的独立危险因素。1毫克DST的临界值适合预测高血压的发生。
