Clinical features of primary bilateral macronodular adrenal hyperplasia
10.3760/cma.j.cn311282-20230801-00016
- VernacularTitle:原发性双侧大结节样肾上腺增生症的临床特征探讨
- Author:
Weiwei ZHOU
1
;
Tingwei SU
;
Yu ZHU
;
Lei JIANG
;
Fukang SUN
;
Yiran JIANG
;
Jun DAI
;
Cui ZHANG
;
Hongchao HE
;
Xu ZHONG
;
Luming WU
;
Sichang ZHENG
;
Weiqing WANG
Author Information
1. 上海交通大学医学院附属瑞金医院内分泌代谢科，上海市内分泌代谢病研究所，国家代谢性疾病临床医学研究中心（上海），国家卫健委内分泌代谢病重点实验室，上海市内分泌肿瘤重点实验室，医学基因组学国家重点实验室，上海 200025
- Keywords:
Primary bilateral macronodular adrenal hyperplasia;
Metabolic alterations;
Sex difference
- From:
Chinese Journal of Endocrinology and Metabolism
2023;39(12):1023-1027
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical profile of primary bilateral macronodular adrenal hyperplasia(PBMAH) and sex difference.Methods:One hundred and forty cases of PBMAH were recruited in our center from 2014, and all patients were evaluated for hormone secretion, adrenal imaging, and metabolic parameters.Results:Overt Cushing′s syndrome accounted for 76.4% of PBMAH cohort and 47.9% were female. The overt group had higher serum cortisol and 24 h urinary free cortisol levels, lower adrenocorticotropic hormone, higher serum cortisol after low-dose dexamethasone suppression tests, larger total adrenal size, and a higher percentage of obesity, hypertension, diabetes mellitus, and hypokalemia than the subclinical group(all P<0.05). When compared with the male group, the female group had smaller adrenal size( P<0.001), lower HbA 1C( P=0.003), higher total cholesterol( P=0.005), and lower density lipoprotein-cholesterol levels( P=0.035). Further, 24 h urinary free cortisol in the male group was found to be positively correlated with diastolic blood pressure, fasting glucose, 2 h postprandial glucose after oral glucose tolerance test(OGTT), and HbA 1C after adjusted for age, body mass index, and onset duration, and was negatively correlated with body mass index and potassium levels. While 24 h urinary free cortisol in the female group was positively correlated only with diastolic blood pressure, fasting glucose, and 2 h postprandial glucose after OGTT(all P<0.05). During follow-up, 80.0% of patients achieved remission after unilateral adrenalectomy, with a recurrence rate of 17.9%. Conclusion:PBMAH related metabolic disorder is more pronounced in overt Cushing′s syndrome and males. Unilateral adrenalectomy as an effective treatment can benefit the majority of patients.
