Minimally Invasive Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, Padua, Italy.
Br J Surg. 2015 Mar;102(4):318-30. doi: 10.1002/bjs.9742. Epub 2015 Feb 2.
Subclinical Cushing's syndrome (SCS) is a condition of biochemical cortisol excess without the classical clinical features of overt hypercortisolism; it may be associated with some consequences of metabolic syndrome. The most appropriate treatment remains controversial. This study aimed to assess the outcomes of adrenalectomy for SCS.
A systematic review was performed. MEDLINE, Embase and Cochrane Databases (1980-2013) were searched for studies reporting the outcomes of unilateral adrenalectomy with respect to hypertension, diabetes, dyslipidaemia, obesity and osteoporosis in patients with SCS. Studies with a questionable diagnosis of SCS, bilateral adrenal involvement and insufficient data were excluded.
Of the 105 papers screened, seven were selected; there were six retrospective studies and one randomized clinical trial, including 230 patients. Data analysis was limited by heterogeneity in definition of SCS and endpoints. Hypercortisolism was cured in all operated patients. Laparoscopy was the preferred approach, with a morbidity rate of 0·8 per cent. A beneficial effect of surgery on blood pressure, glucometabolic control and obesity was evident in all studies, with cure or improvement in 72, 46 and 39 per cent of patients respectively, compared with conservative management. The results for lipid metabolism were equivocal, because of a decrease in triglyceridaemia but discordant effects on cholesterol metabolism among the different studies. No beneficial effects on osteoporosis were found.
Laparoscopic adrenalectomy seems to be beneficial in reversing several metabolic effects of hypercortisolism, with a low morbidity rate. However, the heterogeneity and low quality of the available studies preclude definitive recommendations.
亚临床库欣综合征（SCS）是一种生化皮质醇过量而无显性皮质醇增多症的典型临床特征的疾病；它可能与代谢综合征的某些后果有关。最适当的治疗方法仍有争议。本研究旨在评估肾上腺切除术治疗 SCS 的结果。
进行了系统评价。检索了 MEDLINE、Embase 和 Cochrane 数据库（1980-2013 年），以评估单侧肾上腺切除术治疗 SCS 患者的高血压、糖尿病、血脂异常、肥胖和骨质疏松症结局的研究。排除了可疑 SCS 诊断、双侧肾上腺受累和数据不足的研究。
在筛选的 105 篇论文中，有 7 篇被选中；其中有 6 项回顾性研究和 1 项随机临床试验，共纳入 230 例患者。由于 SCS 的定义和终点存在异质性，数据分析受到限制。所有手术患者的高皮质醇血症均被治愈。腹腔镜检查是首选方法，发病率为 0.8%。所有研究均表明手术对血压、糖代谢控制和肥胖有有益影响，与保守治疗相比，分别有 72%、46%和 39%的患者得到治愈或改善。由于不同研究中甘油三酯降低而胆固醇代谢的效果不一致，因此对脂质代谢的结果存在争议。未发现对骨质疏松有有益影响。
腹腔镜肾上腺切除术似乎有利于逆转皮质醇增多症的多种代谢影响，且发病率低。然而，现有研究的异质性和低质量使得无法做出明确的建议。
