亚临床库欣综合征临床分析

Analysis of subclinical Cushing syndrome

目的提高亚临床库欣综合征的诊治水平。方法回顾分析24例亚临床库欣综合征的临床表现、内分泌检查、影像学检查、治疗方法以及光镜、电镜检查资料。结果24例患者均无典型库欣综合征体征，内分泌检查24h尿游离皮质醇升高18例（75％），皮质醇节律消失12例（50％），小剂量地塞米松抑制试验不被抑制24例（100％），大剂量地塞米松抑制试验不被抑制11例（46％）。CT检查提示肾上腺肿瘤直径1．8～4．5cm，平均3．1cm。24例均行腹腔镜下肾上腺瘤切除术。标本病理报告均为肾上腺皮质腺瘤，电镜下见细胞质内存在较多分泌颗粒。随访3个月，患者血压正常，皮质醇节律恢复。结论内分泌检查尤其是小剂量地塞米松抑制试验对亚临床库欣综合征诊断具有重要意义，诊断明确者手术治疗疗效满意。

Objective To evaluate subclinical Cushing syndrome cases and to improve the diagnosis. Methods A retrospective analysis was done on the data of 24 subclinical Cushing syndrome cases. Clinical data included clinical manifestations, endocrinal tests, imaging, treatments, light microscopic and electron microscopic results. Results No typical sign of Cushing syndrome was found in these 24 cases. Endocrine tests showed that 24-hour urine free cortisol increased in 18 cases （75%）, cortisol rhythm disappeared in 12 cases（50%）, high-dose dexamethasone suppression test was not inhibited in 11 cases （46%）, and low-dose dexamethasone suppression test （LDDST） was not suppressed in all 24 cases （100%）. CT scan showed the average tumor diameter was 3.1（1.8-4.5） cm. Laparoscopic resections of adrenal tumors were performed for all 24 patients. The light microscopic examination of the tumor specimens showed adrenocortical adenoma, and the electron microscopic examination found a greater number of cytoplasmic secretory granules. After 3 months＇ followup, patient＇s blood pressure was normal and the normal cortisol rhythm was detected. Conclusions Endocrine tests, especially LDDST, are important for the diagnosis of subclinical Cushing syndrome. Once a clear diagnosis of subclinical Cushing syndrome is established, the patient should be treated with surgery and will have a satisfactory result in both blood pressure control and endocrinal rhythm.