Kubo Yui, Sone Masakatsu, Katabami Takuyuki, Izawa Shoichiro, Ichijo Takamasa, Tsuiki Mika, Okamura Shintaro, Yoshimoto Takanobu, Otsuki Michio, Takeda Yoshiyu, Suzuki Tomoko, Naruse Mitsuhide, Tanabe Akiyo
Department of Metabolism and Endocrinology, St. Marianna University School of Medicine, Japan.
Department of Diabetes, Endocrinology and Nutrition, Kyoto University, Japan.
Intern Med. 2025 May 15;64(10):1476-1484. doi: 10.2169/internalmedicine.4339-24. Epub 2024 Oct 18.
Objective Cortisol-producing adenoma (CPA) is a major subtype of functional adrenal tumors. CPAs are generally treated with adrenalectomy; however, it is difficult to predict the ideal duration of glucocorticoid replacement after resection. This study explored pre-operative factors predictive of glucocorticoid replacement therapy duration after CPA resection. Mehtods This multicenter retrospective observational study was conducted as part of the Advancing Care and Pathogenesis of Intractable Adrenal Diseases in Japan (ACPA-J) from January 2006 to December 2015. Patients This study was conducted at 10 referral centers and included 124 patients who received hydrocortisone replacement therapy after adrenalectomy for CPA. Results The median duration of replacement therapy was 12 (interquartile range, 5-24) months. In the single regression analysis, the sex (p=0.04), morning adrenocorticotropic hormone (ACTH) level (p=0.02), morning serum cortisol level (p=0.003), midnight serum cortisol level (p<0.001), serum cortisol level after a 1-mg dexamethasone suppression test (p<0.001), presence of lumbar compression fracture (p=0.015), and Cushingoid appearance (p<0.001) were all significantly associated with the replacement therapy duration. In multiple regression analyses, the midnight serum cortisol level and presence of lumbar compression fracture were significantly correlated with the replacement therapy duration after adjusting for other parameters. Conclusion Our results suggest that high midnight serum cortisol levels, which cause persistent suppression of the hypothalamic-pituitary-adrenal axis (HPA axis), contribute to a delay in HPA axis recovery. Lumbar compression fracture is an important symptom that reflects the severity and persistence of cortisol secretion.
目的 皮质醇分泌腺瘤（CPA）是功能性肾上腺肿瘤的主要亚型。CPA一般采用肾上腺切除术治疗；然而，术后糖皮质激素替代治疗的理想时长难以预测。本研究探讨了CPA切除术后糖皮质激素替代治疗时长的术前预测因素。方法 本多中心回顾性观察研究作为日本难治性肾上腺疾病的进展护理与发病机制研究（ACPA-J）的一部分，于2006年1月至2015年12月开展。患者 本研究在10个转诊中心进行，纳入了124例因CPA接受肾上腺切除术后接受氢化可的松替代治疗的患者。结果 替代治疗的中位时长为12（四分位间距，5 - 24）个月。在单因素回归分析中，性别（p = 0.04）、上午促肾上腺皮质激素（ACTH）水平（p = 0.02）、上午血清皮质醇水平（p = 0.003）、午夜血清皮质醇水平（p < 0.001）、1毫克地塞米松抑制试验后的血清皮质醇水平（p < 0.001）、腰椎压缩性骨折的存在（p = 0.015）以及库欣样面容（p < 0.001）均与替代治疗时长显著相关。在多因素回归分析中，调整其他参数后，午夜血清皮质醇水平和腰椎压缩性骨折的存在与替代治疗时长显著相关。结论 我们的结果表明，导致下丘脑 - 垂体 - 肾上腺轴（HPA轴）持续受抑制的高午夜血清皮质醇水平会导致HPA轴恢复延迟。腰椎压缩性骨折是反映皮质醇分泌严重程度和持续性的重要症状。
