亚临床原发性醛固酮增多症合并亚临床库欣综合征1例并文献复习

A case report of subclinical primary aldosterone complicating with subclinical Cushing syndrome and literature review

本文报告1例罕见的亚临床原发性醛固酮增多症(subclinical primary aldosteronism,SPA)合并亚临床库欣综合征(subclinical Cushing syndrome,SCS)患者。该患者为41岁的女性,因肾上腺偶发瘤(adrenal incidentaloma,AI)入院。患者无高血压、低血钾、糖代谢异常等典型的原发性醛固酮增多症(primary aldosteronism,PA)或库欣综合征(Cushing syndrome,CS)的临床表现,实验室检查示醛固酮肾素比值(aldosterone to renin ratio,ARR)>3.7,促肾上腺皮质激素(adrenocorticotropic hormone,ACTH)<1.6 pg/mL,最终依据术后病理学检查结果,患者被诊断为肾上腺皮质腺瘤。该病例中存在2种亚临床疾病共存的诊断,这种临床类型在目前的指南和报道中并未得到充分认识,值得关注并进行更详细的讨论。

This case reports a rare subclinical primary aldosteronism complicated with subclinical Cushing’s syndrome.A 41-year-old female patient was admitted for adrenal incidentaloma,had no clinical manifestations of typical primary aldosteronism or Cushing syndrome,such as hypertension,hypokalemia,abnormal glucose metabolism.Laboratory tests indicated ARR>3.7,ACTH<1.6 pg/mL,and a postoperative pathological diagnosis was adrenal cortical adenoma.Subclinical coexistence of both diseases was presented in this case.This type is not fully recognized in current guidelines and reports,and deserves more detailed discussion.