Katayama M, Nomura K, Ujihara M, Obara T, Demura H
Department of Medicine, Tokyo Women's Medical College, Japan.
Clin Endocrinol (Oxf). 1998 Sep;49(3):311-6. doi: 10.1046/j.1365-2265.1998.00551.x.
Adrenocortical cells change with age in both subcellular morphology and level of steroidogenesis. This study evaluates the influence of aging on hypercortisolism and clinical manifestations in patients with ACTH-independent Cushing's syndrome due to a cortisol-secreting adrenal adenoma (CS).
Restrospective study.
Thirty-six (33 females and 3 males) with CS. 31 healthy controls were age- and sex-matched to CS patients.
Patient age at diagnosis was compared to the degree of hypercortisolism and clinical manifestations. The degree of hypercortisolism was estimated using serum cortisol levels and urinary free cortisol excretion. Positive clinical manifestations were quantified using 12 symptoms and signs which resulted in a clinical score for each patient. Endogenous creatinine clearance, estimated disease duration and gender were analysed as possible factors affecting adenoma-secreated cortisol.
Patient age correlated negatively with serum cortisol level (r = -0.417, P = 0.0107, n = 36) and urinary excretion of free cortisol (r = -0.613, P = 0.0002, n = 31). Analysis of Spearman's rank correlation showed that the clinical score decreased with age (rho = -0.631, P = 0.0004, n = 33). Oedema, weakness/myopathy, hirsutism, striae and psychological changes were infrequent symptoms in the elderly. Using stepwise multiple regression analysis, we estimated the clinical score (Y) by factors of serum cortisol levels (X1:nmol/l), age (X2: years of age) and gender (X3: gender; female = 1, male = 0), i.e. Y = 4.771 + 0.004 X1 - 0.064 X2 + 2.548 X3 (r = 0.743, P < 0.0001, n = 33). Results suggested that aging both suppressed cortisol secretion and repressed manifestations directly as an independent factor, although its direct effect may be weak.
Our findings indicated the importance of age as a factor modulating hormonal levels and possible clinical manifestations in patients with cortisol-secreting adenomas.
肾上腺皮质细胞在亚细胞形态和类固醇生成水平方面均会随年龄发生变化。本研究评估衰老对因分泌皮质醇的肾上腺腺瘤（CS）导致的促肾上腺皮质激素非依赖性库欣综合征患者的皮质醇增多症及临床表现的影响。
回顾性研究。
36例CS患者（33例女性，3例男性）。31名健康对照者在年龄和性别上与CS患者匹配。
将患者诊断时的年龄与皮质醇增多症程度及临床表现进行比较。采用血清皮质醇水平和尿游离皮质醇排泄量评估皮质醇增多症程度。使用12种症状和体征对阳性临床表现进行量化，从而得出每位患者的临床评分。分析内生肌酐清除率、估计的疾病持续时间和性别作为影响腺瘤分泌皮质醇的可能因素。
患者年龄与血清皮质醇水平呈负相关（r = -0.417，P = 0.0107，n = 36），与尿游离皮质醇排泄量呈负相关（r = -0.613，P = 0.0002，n = 31）。Spearman等级相关性分析显示临床评分随年龄降低（rho = -0.63l，P = 0.0004，n = 33）。水肿、虚弱/肌病、多毛症、皮肤紫纹和心理变化在老年患者中为不常见症状。采用逐步多元回归分析，我们通过血清皮质醇水平（X1：nmol/l）、年龄（X2：岁）和性别（X3：性别；女性 = 1，男性 = 0）等因素估计临床评分（Y），即Y = 4.771 + 0.004 X1 - 0.064 X2 + 2.548 X3（r = 0.743，P < 0.0001，n = 33）。结果表明，衰老既是抑制皮质醇分泌的因素，也是直接抑制临床表现的独立因素，尽管其直接作用可能较弱。
我们的研究结果表明年龄作为调节分泌皮质醇腺瘤患者激素水平及可能的临床表现的一个因素具有重要意义。
