肾上腺皮质腺瘤患者高血糖的患病率及术后改变情况的观察

The changes of hyperglycemia in patients with adrenocortical adenoma before and after operation

目的评价肾上腺皮质腺瘤患者高血糖的患病率及术后改变情况。方法选取肾上腺醛固酮瘤(APA组)患者65例、皮质醇瘤(CSA组)患者43例及无功能瘤(NAA组)患者24例行OGTT,并检测激素测值,与原发性高血压(EH组)患者53例及正常对照(NC组)者40名作比较。观察APA、CSA及NAA组行肾上腺肿瘤摘除术后各项指标。结果(1)各组糖尿病患病率分别为44.6%、48.8%、25.0%、24.5%及17.5%。(2)APA、CSA组激素水平与糖代谢指标有相关性。(3)将APA及CSA组分别分为伴或不伴高血糖亚组进行比较,APA组中伴高血糖亚组血醛固酮水平高于不伴高血糖亚组;CSA组中伴高血糖亚组血皮质醇水平高于不伴高血糖亚组。(4)随着术后激素水平的下降,APA、CSA组糖代谢指标得到改善,NAA组激素及糖代指标手术前后比较差异均无统计学意义。3组术后高血糖患病率分为35.4%、32.6%及33.3%。结论功能性肾上腺皮质腺瘤(包括APA和CSA)患者高血糖的患病率升高,其原因与激素的高分泌相关。手术摘除肿瘤,激素高分泌状态解除后,患者的高血糖情况得以改善。

Objective To assess of the change of hyperglycemia in patients with adrenocortical adenoma before and after operation. Methods 65 patients with aldosterone-secreting adenoma（APA）,43 patients with cortisol-secreting adenoma（CSA） and 24 patients of nonfunctional adrenal adenoma（NAA） received measurements of hormones, and insulin index（ISI）,HOMA-IR, area under the curve of glucose（AUCg）and insulin （AUCi） through OGTT were calculated in those patients. And the results were compared with those of 53 patients with essential hypertension（EH） and 58 normal controls（NC）. During follow-up after adrenalectomy, all patients with adrenocortical adenoma underwent determination of the hormones and calculation of OGTT-related indexes to compare with pre-operation results. Results ⑴ The prevalence of diabetes was 44.6%,48.8%,25.0%,24.5% and 17.5% in groups of APA, CSA, NAA, EH, NC respectively. . ⑵ The level of hormone was correlated with blood glucose levels in APA and CSA groups. ⑶ According to the results of OGTT, APA and CSA patients were divided into two subgroups with and without hyperglycemia. The plasma aldosterone was higher in APA patients with hyperglycemia than without hyperglycemia. The 8：00 serum cortisol was higher, but plasma ACTH was lower in CSA patients with hyperglycemia than without hyperglycemia. ⑷ The hyperglycemia in APA and CSA patients was improved after operation, but the glucose differences before versus after operation in NAA patients were not statistically significant. The prevalence of hyperglycemia was 35.4%, 32.6% and 33.3% in groups of APA,CSA and NAA after operation. Conclusions Patients with functional adrenocortical adenoma including APA and CSA, have a significantly high prevalence of hyperglycemia, which is correlated with over secretion of adrenal cortex hormones. After operation, the hyperglycemia in functional adrenocortical adenoma is improved.