Otokida K, Fujiwara T, Oriso S, Kato M
Nihon Jinzo Gakkai Shi. 1989 Jun;31(6):651-6.
A 48-year-old man was admitted for treatment of Cushing's syndrome due to right adrenal adenoma, associated with chronic renal failure (CRF) with a blood urea nitrogen level of 64.2 and serum creatinine level of 3.9 mg/dl. After removal of the adrenal adenoma, the CRF deteriorated with progressive symptoms of anorexia, vomiting and hypertension, and the patient was placed on hemodialysis. Prior to adrenalectomy, the 17 OHCS and 17 KGS in the urine were not so high. However, the urinary 17 KS was high with an elevated 11-oxy fraction. In comparison with 2 patients suffering from adrenal Cushing's syndrome with normal renal function, there were no large accumulated quantities of glucuronic conjugated and unconjugated metabolites in the plasma of the CRF Cushing's syndrome, with confirmation ascribable to the radioimmunoassayable cross-reactivity of the cortisol antiserum used in the radioimmunoassay kit. In the Cushing's syndrome with CRF, almost all the cortisol, which was hypersecreted from the adenoma, was presumed to be converted to the 11-oxy fraction of 17 KS, possibly by activation of hepatic enzymes.
一名48岁男性因右肾上腺腺瘤导致库欣综合征入院治疗，同时伴有慢性肾衰竭（CRF），血尿素氮水平为64.2，血清肌酐水平为3.9mg/dl。切除肾上腺腺瘤后，慢性肾衰竭病情恶化，出现进行性厌食、呕吐和高血压症状，患者接受血液透析治疗。肾上腺切除术前，尿中17-羟皮质类固醇（17 OHCS）和17-酮皮质类固醇（17 KGS）水平并不高。然而，尿17-酮类固醇（17 KS）水平较高，11-氧代部分升高。与2名肾功能正常的肾上腺库欣综合征患者相比，慢性肾衰竭库欣综合征患者血浆中未发现大量葡萄糖醛酸结合和未结合代谢产物的积累，这通过放射免疫分析试剂盒中使用的皮质醇抗血清的放射免疫分析交叉反应得到证实。在伴有慢性肾衰竭的库欣综合征中，几乎所有由腺瘤分泌过多的皮质醇可能通过肝酶激活转化为17 KS的11-氧代部分。
