Clinical characteristics of clinical and subclinical Cushing's syndrome caused by primary bilateral macronodular adrenal hyperplasia
10.11855/j.issn.0577-7402.0072.2025.0512
- VernacularTitle:原发性双侧大结节样肾上腺增生所致临床型和亚临床型库欣综合征的临床特点分析
- Author:
Huai-Jin XU
1
;
Bing LI
;
Kang CHEN
;
Hui-Xin ZHOU
;
Ya-Jing WANG
;
Li ZANG
;
Xian-Ling WANG
;
Yu CHENG
;
Jin DU
;
Qing-Hua GUO
;
Wei-Jun GU
;
Zhao-Hui LYU
;
Jian-Ming BA
;
Jing-Tao DOU
;
Yi-Ming MU
Author Information
1. 南开大学医学院,天津 300071;解放军总医院第一医学中心内分泌科,北京 100853
- Keywords:
primary bilateral macronodular adrenal hyperplasia;
adrenal Cushing's syndrome;
clinical characteristics;
comorbidity
- From:
Medical Journal of Chinese People's Liberation Army
2025;50(7):800-807
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the clinical characteristics of patients with clinical and subclinical Cushing's syndrome caused by primary bilateral macronodular adrenal hyperplasia(PBMAH).Methods A retrospective analysis was performed on the clinical data of 198 patients with Cushing's syndrome caused by PBMAH diagnosed in the First Medical Center of Chinese PLA General Hospital from January 2004 to October 2024.According to clinical manifestations,the patients were classified into clinical type Cushing's syndrome(n=61)and subclinical type Cushing's syndrome(n=137),and the clinical characteristics of the two types were compared.Results The mean age at diagnosis of patients with PBMAH-induced Cushing's syndrome was(53.5±10.4)years,including 118 males and 80 females,with a male-to-female ratio of 1.475:1.Compared with the subclinical type,the clinical type had a higher proportion of females,higher levels of serum cortisol,24-hour urine free cortisol(24 h UFC),and inhibited serum cortisol after low-dose dexamethasone suppression.Additionally,the clinical type had lower plasma ACTH,larger adrenal nodules and a higher risk of surgery(P<0.05)compared with those in subclinical type.The incidences of hypertension,dyslipidemia,obesity,diabetes mellitus,hypokalemia,vitamin D deficiency,osteoporosis,coronary heart disease,and cerebrovascular disease in patients with Cushing's syndrome caused by PBMAH were 87.9%,50.5%,37.1%,36.9%,27.8%,25.9%,18.7%,18.7%and 12.1%,respectively.Among them,compared with subclinical type patients,clinical type patients had higher incidence of hypokalaemia,vitamin D deficiency and osteoporosis(P<0.05),while there were no statistically significant differences in the incidences of other comorbidities between the two types(P>0.05).The results of postoperative follow-up for PBMAH patients showed that the short-term biochemical remission rate of unilateral total adrenalectomy was 41.5%(22/53)and the long-term biochemical remission rate was 32.0%(8/25).The short-term biochemical remission rate of unilateral partial(or nodular)adrenalectomy was 52.9%(9/17),and the long-term biochemical remission rate was 14.3%(1/7).All patients who underwent unilateral total adrenalectomy plus contralateral partial resection developed adrenal insufficiency(3/3),and 1 patient(1/3)relapsed 3.4 years after surgery.Conclusion Clinical and subclinical types of Cushing's syndrome caused by PBMAH have their distinct clinical characteristics.Surgery is an effective treatment for PBMAH,but a certain proportion of patients fail to achieve biochemical remission after non-bilateral total adrenalectomy.
