Department of Internal Medicine, University Hospital Clementino Fraga Filho, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.
J Hypertens. 2012 May;30(5):967-73. doi: 10.1097/HJH.0b013e3283521484.
Subclinical hypercortisolism is a secondary cause of hypertension that had never been evaluated in resistant hypertensive patients, a subgroup of general hypertensive individuals with an expected high prevalence of secondary hypertension.
Four hundred and twenty-three patients with resistant hypertension and ages up to 80 years were screened for the presence of subclinical hypercortisolism by morning serum cortisol after a midnight 1 mg dexamethasone suppression test (DST). Those with morning cortisol of at least 50 nmol/l had hypercortisolism confirmed by two salivary cortisol of at least 3.6 nmol/l collected at 2300 h. Statistical analysis included bivariate tests between those with positive and negative screening test and with and without confirmed hypercortisolism, and logistic regressions to assess their independent correlates.
One hundred and twelve patients (prevalence 26.5%, 95% confidence interval 22.0-31.9%) had the screening test positive for suspected hypercortisolism. None had overt Cushing syndrome. Patients with positive screening were older, more frequently males, had higher prevalences of diabetes and target-organ damage and higher nighttime SBPs than patients with normal screening test results. Thirty-four patients (total prevalence 8.0%, 95% confidence interval: 5.7-11.2%) had confirmed hypercortisolism. Independent correlates of a positive DST were older age (P = 0.007), male sex (P = 0.012) and presence of cardiovascular diseases (P = 0.002) and chronic kidney disease (P = 0.016). Correlates of confirmed subclinical hypercortisolism were older age (P = 0.020), diabetes (P = 0.06) and a nondipping pattern on ambulatory blood pressure monitoring (P = 0.04).
Patients with resistant hypertension had a relatively high prevalence of subclinical hypercortisolism, and its presence is associated with several markers of worse cardiovascular prognosis.
亚临床皮质醇增多症是高血压的继发原因，从未在耐药性高血压患者中进行过评估，这是一般高血压患者中的一个亚组，预计继发高血压的患病率较高。
对 423 名年龄不超过 80 岁的耐药性高血压患者进行筛查，通过午夜 1 毫克地塞米松抑制试验（DST）后的清晨血清皮质醇检测是否存在亚临床皮质醇增多症。那些清晨皮质醇至少为 50nmol/l 的患者通过两次至少 3.6nmol/l 的唾液皮质醇检测来确认皮质醇增多症，两次检测均在 23 点采集。统计分析包括对筛查试验阳性和阴性患者以及确诊皮质醇增多症和未确诊皮质醇增多症患者之间的双变量检验，以及逻辑回归评估其独立相关性。
112 例患者（患病率 26.5%，95%置信区间 22.0-31.9%）的筛查试验阳性，疑似皮质醇增多症。无明显库欣综合征患者。筛查阳性患者年龄较大，男性较多，糖尿病和靶器官损害的患病率较高，夜间 SBP 较高，与正常筛查试验结果患者相比。34 例患者（总患病率 8.0%，95%置信区间：5.7-11.2%）确诊为皮质醇增多症。DST 阳性的独立相关因素是年龄较大（P=0.007）、男性（P=0.012）以及存在心血管疾病（P=0.002）和慢性肾脏疾病（P=0.016）。确诊亚临床皮质醇增多症的相关因素是年龄较大（P=0.020）、糖尿病（P=0.06）和动态血压监测昼夜节律消失（P=0.04）。
耐药性高血压患者亚临床皮质醇增多症的患病率相对较高，其存在与心血管预后不良的多个标志物相关。
