库欣腺瘤患者甲状腺功能与血清皮质醇之间的关联。

Association between thyroid function and serum cortisol in cortisol-producing adenoma patients.

作者信息

Cai Rongrong, Zhou Weiwei, Jiang Lei, Jiang Yiran, Su Tingwei, Zhang Cui, Zhou Wenzhong, Ning Guang, Wang Weiqing

机构信息

Shanghai Key Laboratory for Endocrine Tumors, Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai National Clinical Center for Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200025, PR China.

Laboratory for Endocrine & Metabolic Diseases of Institute of Health Science, Shanghai JiaoTong University School of Medicine and Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, 200025, PR China.

出版信息

Endocrine. 2020 Jul;69(1):196-203. doi: 10.1007/s12020-020-02278-5. Epub 2020 Apr 14.

DOI:10.1007/s12020-020-02278-5

PMID:32291738

Abstract

PURPOSE

Thyroid dysfunction has been reported in hypercortisolism. Previous findings regarding changes in thyroid function due to cortisol-producing adenoma (CPA) have been inconsistent. The study aimed to investigate the association between thyroid function and excessive cortisol secretion in patients with CPA and to explore the changes in pituitary function after adrenalectomy.

METHODS

We conducted a retrospective study; thyroid function was evaluated in 94 patients with CPA and 94 healthy controls (HC) matched for age and sex. A total of 94 patients with nonfunctioning adrenal incidentalomas (NFAIs) were recruited as a second control group.

RESULTS

Serum thyroid stimulating hormone (TSH) and free thyroxine (T4) levels were significantly lower in the CPA group than in the HC and NFAIs groups (P < 0.001). The prevalence of central hypothyroidism was 12.8% in the CPA group and increased according to serum cortisol quartiles (P for trend = 0.025). According to the stepwise multiple linear regression analysis, serum cortisol was negatively associated with TSH and free T4 levels in the CPA group after adjustment for body mass index and age. Furthermore, decreased TSH levels were corrected by adrenalectomy [0.75 (0.50, 1.14) vs. 1.91 (1.36, 2.71) µIU/ml, P < 0.001], in parallel with a recovery in free T4 levels [11.20 (10.00, 12.43) vs. 12.04 (11.24, 13.01), P < 0.001]. Postoperative growth hormone and prolactin levels did not change compared with baseline.

CONCLUSION

Serum TSH and free T4 levels were decreased in patients with CPA, and dysfunction of the hypothalamic-pituitary-thyroid axis might be reversible after surgery.

摘要

目的

已有报道称皮质醇增多症患者存在甲状腺功能障碍。先前关于因分泌皮质醇腺瘤（CPA）导致甲状腺功能变化的研究结果并不一致。本研究旨在调查CPA患者甲状腺功能与皮质醇分泌过多之间的关联，并探讨肾上腺切除术后垂体功能的变化。

方法

我们进行了一项回顾性研究；对94例CPA患者和94名年龄及性别相匹配的健康对照者（HC）的甲状腺功能进行了评估。另外招募了94例无功能肾上腺意外瘤（NFAl）患者作为第二对照组。

结果

CPA组血清促甲状腺激素（TSH）和游离甲状腺素（T4）水平显著低于HC组和NFAl组（P < 0.001）。CPA组中枢性甲状腺功能减退的患病率为12.8%，且根据血清皮质醇四分位数增加（趋势P = 0.025）。根据逐步多元线性回归分析，在调整体重指数和年龄后，CPA组血清皮质醇与TSH和游离T4水平呈负相关。此外，肾上腺切除术后TSH水平降低得到纠正[0.75（0.50，1.14）对1.91（1.36，2.71）μIU/ml，P < 0.001]，同时游离T4水平恢复[11.20（10.00，12.4）对12.04（11.24，13.01），P < 0.001]。术后生长激素和催乳素水平与基线相比无变化。