Department of Diabetes, Endocrinology and Nutrition, Kyoto University, Kyoto, Japan.
Department of Internal Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
J Clin Endocrinol Metab. 2019 Oct 1;104(10):4382-4389. doi: 10.1210/jc.2018-02790.
Adrenal tumors (ATs), even those diagnosed as nonfunctioning, may cause metabolic disorders. Some primary aldosteronism (PA) patients with ATs are diagnosed with bilateral PA based on adrenal venous sampling (AVS), and their ATs are apparently nonfunctioning.
To clarify the influence of apparently nonfunctioning ATs, we compared hormone levels and clinical complications between bilateral PA cases with and without ATs.
DESIGN, SETTING, AND PARTICIPANTS: After retrospectively assessing 2814 patients with PA in the multicenter Japan PA study, bilateral PA cases on AVS were divided into cases with and without ATs by computed tomography findings. Importantly, patients with cortisol levels >1.8 µg/dL after the 1-mg dexamethasone suppression test (DST) were excluded. Clinical characteristics and biochemical data were compared between them. The correlation between AT size and hormone levels was also analyzed.
Analyzed were 196 bilateral PA patients with ATs and 331 those without ATs. Although basal cortisol and aldosterone levels were similar between them, cortisol levels after the 1-mg DST and the prevalences of diabetes mellitus and proteinuria were significantly higher and ACTH levels and plasma renin activity were significantly lower in cases with ATs than in those without. After adjusting for patients' backgrounds, cortisol levels after the 1-mg DST and plasma renin activity remained significantly different between them. Moreover, cortisol levels after the 1-mg DST and ACTH levels correlated with AT size.
Apparently nonfunctioning ATs in bilateral PA cases may cause latent autonomous cortisol secretion, inducing diabetes and proteinuria.
即使被诊断为无功能的肾上腺肿瘤（AT）也可能导致代谢紊乱。一些双侧原发性醛固酮增多症（PA）患者根据肾上腺静脉取样（AVS）被诊断为双侧 PA，且其 AT 显然无功能。
为明确显然无功能的 AT 的影响，我们比较了双侧 PA 伴与不伴 AT 患者的激素水平和临床并发症。
设计、地点和参与者：回顾性评估多中心日本 PA 研究中的 2814 例 PA 患者后，根据 CT 检查结果将 AVS 上的双侧 PA 病例分为伴和不伴 AT 两组。重要的是，排除了皮质醇水平>1.8μg/dL 且经 1mg 地塞米松抑制试验（DST）后的患者。比较了两组患者的临床特征和生化数据。还分析了 AT 大小与激素水平之间的相关性。
分析了 196 例双侧 PA 伴 AT 患者和 331 例无 AT 患者。尽管两组患者的基础皮质醇和醛固酮水平相似，但 AT 组患者的 1mg DST 后皮质醇水平、糖尿病和蛋白尿患病率明显更高，而 ACTH 水平和血浆肾素活性明显更低。调整患者背景后，两组患者的 1mg DST 后皮质醇水平和血浆肾素活性仍有显著差异。此外，1mg DST 后皮质醇水平与 ACTH 水平与 AT 大小相关。
双侧 PA 病例中显然无功能的 AT 可能引起潜在的自主皮质醇分泌，导致糖尿病和蛋白尿。
