aDepartment of Medicine and Clinical Science, Kyoto University Graduate School of Medicine bDepartment of Clinical Trial Design & Management, Translational Research Center, Kyoto University Hospital cEBM Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan.
J Hypertens. 2013 Oct;31(10):2010-7. doi: 10.1097/HJH.0b013e3283635789.
After unilateral adrenalectomy (uADX) in patients with a unilateral aldosterone-producing adenoma (APA), the remaining contralateral adrenal gland is generally considered sufficient to support life. However, few studies have compared adrenal reserve function before and after uADX. Therefore, we closely evaluated adrenal cortisol secretory function before and after uADX in patients with unilateral APA.
Patients who were diagnosed with APA and underwent uADX for unilateral APA were initially included in this study. Patients with subclinical Cushing's syndrome (SCS) or Cushing's syndrome were excluded on suspicion of autonomous cortisol secretion. Fourteen patients were finally evaluated. Morning basal serum cortisol and plasma adrenocorticotropin hormone (ACTH) levels were measured, and ACTH stimulation tests under 1-mg dexamethasone suppression (dex-ACTH test) were performed before and after uADX.
No patient developed clinical adrenal insufficiency. Basal cortisol levels were not significantly different before and after uADX. However, basal ACTH levels were significantly elevated after uADX. In addition, peak cortisol levels on the dex-ACTH test decreased in all patients after uADX. The peak cortisol level after uADX was 86.6 (81.4-92.4)% of the level before uADX.
The adrenal cortisol secretory response to ACTH stimulation is mildly reduced after uADX in patients with unilateral APA without SCS or Cushing's syndrome, although their basal cortisol level is sustained by elevated ACTH. These data will be important as a point of discussion when patients with unilateral APA consider either uADX or specific pharmacotherapy as treatment options.
单侧醛固酮瘤（APA）患者行单侧肾上腺切除术（uADX）后，剩余的对侧肾上腺通常被认为足以维持生命。然而，很少有研究比较 uADX 前后的肾上腺储备功能。因此，我们密切评估了单侧 APA 患者 uADX 前后的肾上腺皮质醇分泌功能。
本研究最初纳入了被诊断为 APA 并因单侧 APA 而行 uADX 的患者。怀疑自主皮质醇分泌的亚临床库欣综合征（SCS）或库欣综合征患者被排除在外。最终评估了 14 例患者。测量了早晨基础血清皮质醇和血浆促肾上腺皮质激素（ACTH）水平，并在 uADX 前后进行了 1mg 地塞米松抑制（dex-ACTH 试验）的 ACTH 刺激试验。
无患者发生临床肾上腺功能不全。uADX 前后基础皮质醇水平无显著差异。然而，uADX 后基础 ACTH 水平显著升高。此外，所有患者在 uADX 后 dex-ACTH 试验的皮质醇峰值均下降。uADX 后的皮质醇峰值为 uADX 前的 86.6%（81.4-92.4）%。
在无 SCS 或库欣综合征的单侧 APA 患者中，uADX 后 ACTH 刺激的肾上腺皮质醇分泌反应轻度降低，尽管其基础皮质醇水平因 ACTH 升高而维持。这些数据将是讨论单侧 APA 患者考虑单侧肾上腺切除术或特定药物治疗作为治疗选择的重要依据。
