Invitti C, Manfrini R, Romanini B M, Cavagnini F
2nd Chair of Endocrinology, University of Milan, Italy.
Clin Endocrinol (Oxf). 1995 Sep;43(3):359-63. doi: 10.1111/j.1365-2265.1995.tb02044.x.
In the recent past, we have noted a frequent occurrence of thyroid nodules in our patients with Cushing's disease. We therefore elected to evaluate thyroid structure and function in these patients and also in patients with Cushing's syndrome of primary adrenal origin.
In 33 of the 37 patients (30 women and 3 men aged 19-66 years) with endogenous hypercortisolism referred to our Institution during the last five years, measurement of T4, T3, FT4, FT3, TSH serum levels and thyroid ultrasonography were performed, at first admission in 15 cases and subsequently in the course of follow-up in 18 cases. At the time of the study, 16 of the 33 patients had active Cushing's disease while 9 were in remission after successful surgery, 6 patients had an adrenal tumour and 2 patients had previously undergone unilateral adrenalectomy for an adrenal adenoma. Thyroid function and ultrasonography were also evaluated in 55 normal subjects, 40 women and 15 men aged 20-73 years.
In 25 patients with Cushing's disease, we found a significantly higher prevalence of thyroid nodular disease than that recorded in 55 control subjects (60.0 vs 20.0%, chi 2 = 10.779, P < 0.005) and comparable to that in patients with active disease (56.2%) and those in remission (66.6%). Multiple nodules were present in 8 Cushing's patients and in 4 normal subjects while a single nodule was detected in 7 patients and in 7 controls. A markedly lower occurrence of thyroid abnormality was found in the 8 patients with adrenal tumours (25.0%, NS vs controls). In 9/17 (52.9%) patients with ultrasonographic evidence of thyroid nodules, these were palpable. As expected, serum thyroid hormone and TSH levels were reduced in patients with active Cushing's syndrome compared to normal controls.
We found a significantly higher prevalence of nodular thyroid disease in patients with Cushing's disease with respect to a group of controls in whom the prevalence of thyroid nodules was comparable to that reported for the general population in Europe. The possibility that glucocorticoid excess is responsible for the development of thyroid changes does not seem likely since in our small series of patients with adrenal tumours the prevalence was only slightly higher than that observed in control subjects. Other factors related to hyperactivity of the corticotrophic cell, or a growth factor stimulating both corticotroph and thyrocyte proliferation might be involved. Evaluation of a larger series of patients with adrenal tumours may help to distinguish between these possibilities.
最近，我们注意到库欣病患者中甲状腺结节频繁出现。因此，我们选择评估这些患者以及原发性肾上腺来源的库欣综合征患者的甲状腺结构和功能。
在过去五年转诊至我们机构的37例内源性皮质醇增多症患者中，对33例患者（30名女性和3名男性，年龄19 - 66岁）进行了研究。在首次入院时对15例患者进行了血清T4、T3、FT4、FT3、TSH水平测定及甲状腺超声检查，随后在随访过程中对18例患者进行了检查。研究时，33例患者中16例患有活动性库欣病，9例在成功手术后处于缓解期，6例患有肾上腺肿瘤，2例此前因肾上腺腺瘤接受了单侧肾上腺切除术。还对55名正常受试者（40名女性和15名男性，年龄20 - 73岁）进行了甲状腺功能和超声检查。
在25例库欣病患者中，我们发现甲状腺结节性疾病的患病率显著高于55名对照受试者（60.0%对20.0%，χ² = 10.779，P < 0.005），与活动性疾病患者（56.2%）和缓解期患者（66.6%）的患病率相当。8例库欣病患者和4名正常受试者有多个结节，7例患者和7名对照受试者发现单个结节。8例肾上腺肿瘤患者中甲状腺异常的发生率明显较低（25.0%，与对照相比无统计学差异）。在17例有甲状腺结节超声证据的患者中，9例（52.9%）可触及结节。正如预期的那样，与正常对照相比，活动性库欣综合征患者的血清甲状腺激素和TSH水平降低。
我们发现库欣病患者中结节性甲状腺疾病的患病率显著高于一组对照受试者，该组对照受试者的甲状腺结节患病率与欧洲一般人群报告的患病率相当。糖皮质激素过多导致甲状腺改变的可能性似乎不大，因为在我们这一小系列肾上腺肿瘤患者中，患病率仅略高于对照受试者。可能涉及与促肾上腺皮质激素细胞活性过高相关的其他因素，或刺激促肾上腺皮质激素细胞和甲状腺细胞增殖的生长因子。对更多肾上腺肿瘤患者的评估可能有助于区分这些可能性。
