Comparison of clinical characteristics between primary bilateral macronodular adrenal hyperplasia and adrenal cortisol-producing adenoma
10.11855/j.issn.0577-7402.0487.2025.0611
- VernacularTitle:原发性双侧肾上腺大结节增生与肾上腺皮质醇分泌腺瘤的临床特征比较
- Author:
Bing LI
1
;
Ming-Xiu YANG
;
Huai-Jin XU
;
Jing-Xuan WANG
;
Qing-Zheng WU
;
Ya-Jing WANG
;
Yi-Jun LI
;
Kang CHEN
;
Yu CHENG
;
Qi NI
;
Ya-Qi YIN
;
Li ZANG
;
Qing-Hua GUO
;
Jian-Ming BA
;
Wei-Jun GU
;
Jing-Tao DOU
;
Zhao-Hui LYU
;
Yi-Ming MU
Author Information
1. 解放军总医院第一医学中心内分泌科,北京 100853
- Keywords:
Cushing's syndrome;
primary bilateral adrenal macronodular adrenal hyperplasia;
adrenal cortical-secreting adenoma
- From:
Medical Journal of Chinese People's Liberation Army
2025;50(7):779-785
- CountryChina
- Language:Chinese
-
Abstract:
Objective To comparatively analyze the clinical characteristics of primary bilateral macronodular adrenal hyperplasia(PBMAH)and adrenal cortisol-producing Adenoma(CPA),and enhance the understanding of two diseases.Methods The clinical data of 85 PBMAH patients(PBMAH group)and 195 CPA patients(CPA group)diagnosed at Department of Endocrinology,the First Medical Center of Chinese PLA General Hospital,from September 2014 to August 2024 were retrospectively analyzed.The demographic characteristics,comorbidities,biochemical indicators,adrenocorticotropic hormone-cortisol(ACTH-F)levels,and adrenal imaging features and treatment conditions were compared between the two groups.Results(1)General characteristics:Compared with CPA group,PBMAH group had older age at diagnosis and a higher proportion of male patients.(2)Clinical characteristics:Compared with CPA group,PBMAH group had a longer disease duration,a higher proportion of subclinical Cushing's syndrome(CS),and a higher proportion of hypertension,impaired glucose tolerance/diabetes,bone mass reduction or osteoporosis,with higher serum potassium levels,and the differences were statistically significant(P<0.01).(3)Hormone levels:Both PBMAH and CPA groups showed ACTH-F rhythm disorder,significantly increased cortisol levels and suppressed ACTH.Compared with PBMAH group,CPA group had stronger autonomous cortisol secretion ability,manifested by increased midnight serum cortisol(F0:00),16:00 serum cortisol(F16:00),24-hour urinary free cortisol(24 h UFC)levels and lower 8:00 serum ACTH(ACTH8:00)and 16:00 serum ACTH(ACTH16:00)(P<0.01).After low-dose dexamethasone suppression test(LDDST),CPA group showed lower suppression rates of ACTH and cortisol,and higher proportions of paradoxical elevation in serum cortisol and 24 h UFC compared with PBMAH(P<0.01).Conclusions PBMAH has a longer disease course and higher proportions of comorbid metabolic disorders than CPA,mostly manifested as subclinical Cushing's syndrome.CPA has stronger autonomous cortisol secretion ability,with cortisol less likely to be suppressed after LDDST and more obvious paradoxical elevation of cortisol and 24 h UFC.
