Numakura Kazuyuki, Nara Taketoshi, Kanda Sohei, Saito Mitsuru, Narita Shintaro, Inoue Takamitsu, Habuchi Tomonori
Department of Urology, Akita University Graduate School of Medicine, Akita, Japan.
Front Endocrinol (Lausanne). 2019 Aug 20;10:572. doi: 10.3389/fendo.2019.00572. eCollection 2019.
Glucocorticoid (GC) is known to be involved in the deterioration of kidney function both directly by affecting the glomeruli and renal tubules and indirectly by affecting cardiovascular function. Autonomous GC secretion is the main feature of primary adrenal hypercortisolism (PAHC). However, the ideal treatment option (operation vs. medical treatment and observation) for patients with PAHC has not been established yet. In this study, we assessed a time series of kidney function in patients with PAHC treated via laparoscopic adrenalectomy and investigated the predictive factors for kidney function 1 year after surgery. From September 1997 to July 2017, 175 laparoscopic adrenalectomies were performed for adrenal tumors at Akita University. Thirty patients, who were diagnosed as having PAHC via preoperative endocrinological evaluations and followed up for at least 1 year after surgery, were included in this study. Patients with severe complications or simultaneous aldosteronism were excluded. The mean age of the 30 patients was 57.5 years (range, 33-79 years; males, 4; females, 26), and the right and left sides were affected in 9 and 21 patients, respectively. In all, 18 patients were diagnosed as having Cushing's syndrome and 12 as having subclinical Cushing's syndrome. The steroid cover was required in all cases after surgery. The estimated glomerular filtration rate significantly improved (78.4 mL/min [64.8-95.8] vs. 84.1 mL/min [66.8-104.0], = 0.012) 1 year after surgery. Patients showing 5% or more improvement in kidney function and those showing less than 5% improvement were compared. On performing univariate analyses, factors such as a longer operative time, heavy body mass index (BMI), and preoperative unsuppressed ACTH were associated with worse improvement in kidney function. No significant associations were observed regarding metabolic disorders, clinical symptoms, and gross proteinuria. On multivariate analysis, patients with a higher BMI (≥ 24 kg/m) showed worse improvement in kidney function at 1 year after surgery (odds ratio 14.0, 95% confidence interval 1.3-142.9, = 0.012). In PAHC patients, after 1 year of follow-up, kidney function improved in terms of estimated glomerular filtration rate. Therefore, this improvement seems to be delayed in overweight patients, suggesting its direct role in renal function.
已知糖皮质激素（GC）可通过影响肾小球和肾小管直接参与肾功能恶化，也可通过影响心血管功能间接参与。自主性GC分泌是原发性肾上腺皮质醇增多症（PAHC）的主要特征。然而，PAHC患者的理想治疗方案（手术治疗与药物治疗及观察）尚未确定。在本研究中，我们评估了经腹腔镜肾上腺切除术治疗的PAHC患者的肾功能时间序列，并调查了术后1年肾功能的预测因素。1997年9月至2017年7月，秋田大学对175例肾上腺肿瘤患者实施了腹腔镜肾上腺切除术。本研究纳入了30例经术前内分泌评估诊断为PAHC且术后至少随访1年的患者。排除有严重并发症或同时患有醛固酮增多症的患者。30例患者的平均年龄为57.5岁（范围33 - 79岁；男性4例，女性26例），右侧和左侧受影响的患者分别为9例和21例。共有18例患者被诊断为库欣综合征，12例为亚临床库欣综合征。所有病例术后均需要激素替代治疗。术后1年，估计肾小球滤过率显著改善（78.4 mL/min [64.8 - 95.8] 对比 84.1 mL/min [66.8 - 104.0]，P = 0.012）。对肾功能改善5%或更多的患者与改善不足5%的患者进行了比较。单因素分析显示，手术时间较长、体重指数（BMI）较高以及术前促肾上腺皮质激素（ACTH）未被抑制等因素与肾功能改善较差有关。在代谢紊乱、临床症状和大量蛋白尿方面未观察到显著相关性。多因素分析显示，BMI较高（≥24 kg/m²）的患者术后1年肾功能改善较差（比值比14.0，95%置信区间1.3 - 142.9，P = 0.012）。在PAHC患者中，随访1年后，估计肾小球滤过率方面的肾功能有所改善。因此，超重患者的这种改善似乎延迟，提示其在肾功能中的直接作用。
