应用双能 X 射线吸收仪评估无功能性肾上腺意外瘤伴中间表型患者的体成分：与代谢综合征有关吗？
Evaluation of body composition using dual-energy X-ray absorptiometry in patients with non-functioning adrenal incidentalomas and an intermediate phenotype: Is there an association with metabolic syndrome?
机构信息
Department of Internal Medicine and Endocrine Unit, Federal University of Rio de Janeiro, School of Medicine, Clementino Fraga Filho University Hospital, Rua Professor Rodolpho Paulo Rocco, 255. 9 Floor - Endocrine Unit, Rio De Janeiro, RJ, 21941-913, Brazil.
Department of Internal Medicine and Rheumatology Unit, Federal University of Rio de Janeiro, School of Medicine, Clementino Fraga Filho University Hospital, Rio De Janeiro, RJ, Brazil.
出版信息
J Endocrinol Invest. 2019 Jul;42(7):797-807. doi: 10.1007/s40618-018-0985-y. Epub 2018 Nov 21.
PURPOSE
Metabolic syndrome (MS) and sarcopenia are associated with increased cardiovascular risk. No studies using dual-energy x-ray absorptiometry (DXA) have evaluated association between body composition (BC) changes and MS in adrenal incidentaloma (AI). Our aim was to analyse BC in non-functioning AI (NFAI) and intermediate phenotype (IP) relative to controls and to correlate with cortisol levels.
METHODS
Cross-sectional study with 44 NFAI (serum cortisol ≤ 50 nmol/L after the overnight 1 mg dexamethasone suppression test), 27 IP (cortisol 51-138 nmol/L), and 41 controls (normal adrenal on imaging examination) using DXA. Autonomic cortisol secretion (cortisol > 138 nmol/L) was excluded from the study. BC data were compared using criteria for MS (World Health Organization, National Cholesterol Education Program-Adult Treatment Panel-III, American Association of Clinical Endocrinologists (AACE), and International Diabetes Federation).
RESULTS
There was no significant difference in clinical data and body mass index (BMI) among the three groups. Waist circumference (WC) was larger in AI vs. controls (p < 0.01). Waist-to-hip ratio was higher in NFAI vs. controls and waist-to-height ratio was higher in IP vs. controls (p = 0.03 and p = 0.02, respectively). The frequency of MS was higher in AI vs. controls. BC was not different among the groups. Patients with AI there was a significant association of MS with both an increase in total fat and body fat index (all criteria), and a significant difference between MS and smaller BMI-adjusted lean mass (AACE, p = 0.036). No correlation of cortisol after 1 mg dexamethasone test with BC or MS. AI and WC were independently associated with MS.
CONCLUSIONS
AI presented high frequency of MS and was independently associated with MS. Possible deleterious effects of cortisol secretion seem to initially affect the muscular system.
目的
代谢综合征（MS）和肌肉减少症与心血管风险增加有关。使用双能 X 射线吸收法（DXA）的研究尚未评估肾上腺偶发瘤（AI）中身体成分（BC）变化与 MS 的关系。我们的目的是分析无功能 AI（NFAI）和中间表型（IP）与对照组之间的 BC，并与皮质醇水平相关。
方法
横断面研究纳入 44 例 NFAI（隔夜 1 毫克地塞米松抑制试验后血清皮质醇≤50nmol/L）、27 例 IP（皮质醇 51-138nmol/L）和 41 例对照组（影像学检查正常肾上腺），采用 DXA。自主皮质醇分泌（皮质醇>138nmol/L）被排除在研究之外。使用世界卫生组织（WHO）、美国国家胆固醇教育计划-成人治疗专家组 III（NCEP-ATP III）、美国临床内分泌医师协会（AACE）和国际糖尿病联合会（IDF）的标准比较 BC 数据。
结果
三组之间的临床数据和体重指数（BMI）无显著差异。AI 组的腰围（WC）大于对照组（p<0.01）。NFAI 组的腰臀比高于对照组，IP 组的腰围身高比高于对照组（p=0.03 和 p=0.02）。AI 组 MS 发生率高于对照组。三组间 BC 无差异。AI 患者中，MS 与总脂肪和体脂指数增加均显著相关（所有标准），MS 与较小的 BMI 调整后瘦体重之间存在显著差异（AACE，p=0.036）。1 毫克地塞米松试验后皮质醇与 BC 或 MS 无相关性。AI 和 WC 与 MS 独立相关。
结论
AI 中 MS 发生率高，与 MS 独立相关。皮质醇分泌的可能有害影响似乎最初影响肌肉系统。
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