原发性双侧巨结节性肾上腺增生伴自主皮质醇分泌的患病率和表型：98 例患者研究。

Prevalence and phenotype of primary bilateral macronodular adrenal hyperplasia with autonomous cortisol secretion: a study of 98 patients.

机构信息

Servicio de Endocrinología y Nutrición, Hospital Universitario Ramón y Cajal, Madrid, Spain.

Servicio de Endocrinología y Nutrición, Hospital Universitario Ramón y Cajal, Madrid, Spain; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Centro de Investigación Biosanitaria en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid. Spain.

出版信息

Rev Clin Esp (Barc). 2022 Oct;222(8):458-467. doi: 10.1016/j.rceng.2022.01.003. Epub 2022 May 18.

DOI:10.1016/j.rceng.2022.01.003

PMID:35597729

Abstract

AIM

This study evaluated prevalence of primary bilateral macronodular adrenal hyperplasia (PBMAH). It also analyzed the differential phenotype of patients with PBMAH compared to other bilateral adrenal lesions that do not meet the definition of PBMAH.

METHODS

We reviewed the medical records of 732 patients diagnosed with an adrenal incidentaloma at our center. Ninety-eight patients with subclinical hypercortisolism were included in the analysis. We defined PBMAH as the presence of plasma cortisol > 1.8 μg/dL after an over-night 1-mg dexamethasone test, bilateral adrenal hyperplasia, and bilateral adrenal nodules > 1 cm.

RESULTS

A total of 31 patients had PBMAH. Patients with PBMAH showed greater prevalence of autonomous cortisol secretion (plasma cortisol > 5.0 μg/dL after an overnight 1-mg dexamethasone test) than patients without PBMAH (OR 4.1, 95%CI 1.38-12.09, p = 0.010). Tumor size and total adenomatous mass were significantly greater in patients with PBMAH compared to patients without PBMAH (30.2 ± 12.16 vs. 24.3 ± 8.47 mm, p = 0.010 and 53.9 ± 20.8 vs. 43.3 ± 14.62 mm, p = 0.023), respectively. A greater proportion of patients with PBMAH had diabetes compared to patients without PBMAH (45.2% vs. 25.4%, p = 0.05).

CONCLUSION

PBMAH is present in one-third of patients with adrenal incidentaloma and subclinical hypercortisolism. Patients with PBMAH showed greater autonomous cortisol secretion, bigger tumor size, and higher rates of diabetes than those without PBMAH.

摘要

目的

本研究评估了原发性双侧大结节性肾上腺增生（PBMAH）的患病率。还分析了 PBMAH 患者与不符合 PBMAH 定义的其他双侧肾上腺病变患者之间的差异表型。

方法

我们回顾了在我们中心诊断为肾上腺意外瘤的 732 名患者的病历。98 名亚临床皮质醇增多症患者纳入分析。我们将 PBMAH 定义为过夜 1mg 地塞米松试验后血浆皮质醇>1.8μg/dL、双侧肾上腺增生和双侧肾上腺结节>1cm。

结果

共有 31 名患者患有 PBMAH。与无 PBMAH 患者相比，PBMAH 患者自主皮质醇分泌（过夜 1mg 地塞米松试验后血浆皮质醇>5.0μg/dL）的发生率更高（OR 4.1，95%CI 1.38-12.09，p=0.010）。与无 PBMAH 患者相比，PBMAH 患者的肿瘤大小和总腺瘤质量均显著更大（30.2±12.16 与 24.3±8.47mm，p=0.010 和 53.9±20.8 与 43.3±14.62mm，p=0.023）。与无 PBMAH 患者相比，PBMAH 患者中糖尿病的比例更高（45.2%与 25.4%，p=0.05）。