Objective To evaluate the clinical characteristics of patients with adrenocorticotropin-independent macronodular adrenal hyperplasia (AIMAH).Methods A total of 10 AIMAH cases were enrolled in this retrospective study.The clinical and laboratory findings of all patients were collected and analyzed.Results All patients manifested some clinical features and biochemical evidence of Cushing's syndrome.The plasma adrenocorticotropic hormone (ACTH) level was undetectable in all the patients and their serum cortisol secretion rhythm was abnormal.Low and high-dose dexamethasone suppression tests failed to suppress the cortisol secretion.The bilateral macronodular adrenal enlargement was shown by CT/magnetic resonance imaging.The supine-upright posture test was positive in four patients.Three patients were performed bilateral adrenalectomy,five were unilateral adrenalectomy and the remaining two patients were taken propranolol.All the patients had followed up for 10 to 89 months.Contralateral adrenalectomy was performed in two patients with recurrent symptoms after unilateral adrenalectomy and two patients given propranolol were underwent bilateral adrenalectomy when their symptoms had not been improved or recurred.Conclusion AIMAH is a relatively rare subtype of Cushing's syndrome with unique clinical and laboratory findings.Propranolol is a good choice if the supine-upright posture test is positive.Unilateral adrenalectomy appears to be an effective and safe alternative treatment for AIMAH.Bilateral adrenalectomy could be performed if the symptoms have not been improved or recurred after unilateral adrenalectomy.

Objective To study the platelet inhibition rate of foreign clopidogrel,domestic clopidogrel,combined domestic clopidogrel and tongxinluo and their effct on major adverse cardiovacular events (MACE) after PCI.Methods Two hundred and twenty patients after PCI were divided into foreign clopidogrel treatment group (n=77),domestic clopidogrel treatment group (n=80),combined domesticclopidogrel and tongxinluo treatment group (n =63).The high platelet reactivity (HPR) in 3 groups was detected by thrombelastography after PCI.The incidence of MACE in 3 groups was compared.Results The incidence of left anterior descending branch lesion was lower,the number of sacculi was smaller,and the incidence of HPR was higher in foreign clopidogrel treatment group than in domestic clopidogrel treatment group and combined domestic clopidogrel and tongxinluo treatment group after PCI (63.6％ vs 87.5％ vs 77.8％,P=0.002;2.3±1.1 vs 2.8±1.4 vs 2.7±1.5,P=0.026;24.7％ vs 21.3％ vs 11.1％,P=0.030).The incidence of HPR was significantly higher in foreign clopidogrel treatment group than in combined domestic clopidogrel and tongxinluo treatment group (24.7 ％ vs 11.1％,P =0.040).No significant difference was found in the incidence of MACE in 3 groups (P ＞ 0.05).Conclusion The incidences of MACE of domestic clopidogrel and foreign clopidogrel are similar.Combined clopidogrel and tongxinluo can improve the platelet inhibition rate after PCI.