Ognjanović Sanja, Macut Djuro, Petakov Milan, Elezović Kovačević Valentina, Isailović Tatjana, Bozić Antić Ivana, Ilić Dušan, Popović Bojana, Bogavac Tamara, Pekmezović Tatjana, Damjanović Svetozar
Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Belgrade, Serbia.
Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
J Med Biochem. 2016 Nov 2;35(4):401-409. doi: 10.1515/jomb-2016-0020. eCollection 2016 Oct.
Adrenal incidentalomas (AI) are clinically silent adrenal masses that are detected incidentally during imaging procedures performed for unrelated diseases. The aim of this study was to investigate the prevalence of sub-clinical hypercortisolism (SH) and associated co-morbidities in patients with unilateral AI (UAI) and bilateral AI (BAI).
We evaluated 152 patients, 105 (69.1%) with UAI and 47 (30.9%) with BAI. SH was diagnosed in the presence of serum cortisol levels after 1 mg dexamethasone suppression test (DST) or after 2-day low-dose DST (LDDST) > 50 nmol/L with at least one of the following parameters: midnight serum cortisol > 208 nmol/L, 24-h urinary free cortisol > 245 nmol/24 h, or ACTH < 10 ng/L. Bone mineral density (BMD) was measured at lumbar spine (LS) and femoral neck (FN).
Age, BMI, and waist circumference were comparable, and diabetes, hypertension and dyslipidemia occurred with similar frequency in both groups. The overall prevalence of SH was 20.5% based on post-1 mg DST, and 20.0% based on post-LDDST cortisol levels, and it was more prevalent in BAI than UAI patients (31.1% 15.2%, respectively, p=0.026). LS BMD was lower in BAI than in UAI patients (0.96±0.14 0.87±0.15, p=0.002). There were no differences in FN BMD. The prevalence of osteoporosis was higher in BAI compared to UAI patients (37.1% 15.9%, respectively, p=0.011).
Patients with BAI had higher prevalence of SH and osteoporosis than those with UAI. Frequency of other co-morbidities was similar. This may be due to the higher degree of autonomous cortisol secretion or different tissue-specific sensitivity to glucocorticoids.
肾上腺偶发瘤（AI）是在因其他无关疾病进行影像学检查时偶然发现的临床上无症状的肾上腺肿块。本研究的目的是调查单侧肾上腺偶发瘤（UAI）和双侧肾上腺偶发瘤（BAI）患者亚临床皮质醇增多症（SH）的患病率及相关合并症。
我们评估了152例患者，其中105例（69.1%）为UAI，47例（30.9%）为BAI。在1毫克地塞米松抑制试验（DST）后或2天低剂量DST（LDDST）后血清皮质醇水平>50 nmol/L，且具备以下参数至少一项时诊断为SH：午夜血清皮质醇>208 nmol/L、24小时尿游离皮质醇>245 nmol/24小时或促肾上腺皮质激素（ACTH）<10 ng/L。在腰椎（LS）和股骨颈（FN）测量骨密度（BMD）。
两组患者的年龄、体重指数（BMI）和腰围相当，糖尿病、高血压和血脂异常的发生率相似。基于1毫克DST后结果，SH的总体患病率为20.5%，基于LDDST后皮质醇水平的患病率为20.0%，且BAI患者中的患病率高于UAI患者（分别为31.1%和15.2%，p = 0.026）。BAI患者的LS BMD低于UAI患者（0.96±0.14对0.87±0.15，p = 0.002）。FN BMD无差异。与UAI患者相比，BAI患者骨质疏松症的患病率更高（分别为37.1%和15.9%，p = 0.011）。
BAI患者的SH和骨质疏松症患病率高于UAI患者。其他合并症的发生率相似。这可能是由于皮质醇自主分泌程度较高或对糖皮质激素的不同组织特异性敏感性所致。
