Endocr Pract. 2019 Aug;25(8):846-853. doi: 10.4158/EP-2019-0047. Epub 2019 May 9.
Adrenal incidentalomas are increasingly detected with the widespread use of thoracic and abdominal imaging. The most common secretory syndrome in adrenal nodules is autonomous cortisol secretion (ACS). Recent data show that even mild cortisol excess is associated with adverse outcomes. The glucocorticoid receptor antagonist mifepristone has been used in patients with overt Cushing syndrome and hyperglycemia. The purpose of our study was to determine the effect of mifepristone on metabolic parameters in patients with ACS and concomitant prediabetes or diabetes. Eight patients with either unilateral or bilateral adrenal nodules with ACS were included in the study. Fasting laboratory tests including glucose and insulin levels to calculate homeostatic model assessment for insulin resistance (HOMA-IR) were performed at baseline and again after either 3 months (3 patients) or 6 months (5 patients) on mifepristone 300 mg daily treatment. Patients also completed several validated surveys on mood and quality of life at baseline and follow-up. There were significant reductions in fasting glucose measurements and insulin resistance as measured by HOMA-IR in the 6 of 8 study patients in whom these measurements were available ( = .03). This pilot study demonstrates that mifepristone treatment of ACS is associated with a significant decrease in fasting glucose and insulin resistance as measured by HOMA-IR scores. Mifepristone treatment of ACS may be considered as a medical option for patients with ACS due to adrenal adenomas with concomitant abnormal glucose parameters in whom surgical removal is not being considered. = autonomous cortisol secretion; = adrenocorticotropic hormone; = adrenal incidentaloma; = dehydroepiandrosterone sulfate; = glucocorticoid receptor; = hemoglobin A1c; = homeostatic model assessment for insulin resistance; = overnight dexamethasone suppression test; = quality of life; = state trait anxiety inventory; = thyroid stimulating hormone; = urinary free cortisol.
肾上腺意外瘤随着胸部和腹部影像学的广泛应用而越来越多地被发现。肾上腺结节中最常见的分泌综合征是自主皮质醇分泌（ACS）。最近的数据表明，即使是轻度的皮质醇过多也与不良结局相关。糖皮质激素受体拮抗剂米非司酮已被用于治疗显性库欣综合征和高血糖症患者。我们的研究目的是确定米非司酮对 ACS 合并糖尿病前期或糖尿病患者代谢参数的影响。
研究纳入了 8 例单侧或双侧肾上腺结节 ACS 患者。在基线时和米非司酮 300mg 每日治疗 3 个月（3 例）或 6 个月（5 例）后，再次进行空腹实验室检查，包括血糖和胰岛素水平，以计算稳态模型评估的胰岛素抵抗（HOMA-IR）。患者还在基线和随访时完成了几项关于情绪和生活质量的经过验证的调查。
在 8 例研究患者中有 6 例可获得这些测量值，空腹血糖测量值和 HOMA-IR 测量的胰岛素抵抗均显著降低（=0.03）。
这项初步研究表明，米非司酮治疗 ACS 与空腹血糖和 HOMA-IR 评分测量的胰岛素抵抗显著降低相关。对于由于肾上腺腺瘤而导致 ACS 并伴有异常血糖参数但不考虑手术切除的患者，米非司酮治疗 ACS 可能被视为一种医学选择。
ACS = 自主皮质醇分泌；ACTH = 促肾上腺皮质激素；AI = 肾上腺意外瘤；DHEAS = 硫酸脱氢表雄酮；GR = 糖皮质激素受体；HbA1c = 糖化血红蛋白；HOMA-IR = 稳态模型评估的胰岛素抵抗；过夜地塞米松抑制试验；QoL = 生活质量；STAI = 状态特质焦虑量表；TSH = 促甲状腺激素；UFC = 尿游离皮质醇。
