Clinical characteristics analysis of bilateral macronodular adrenal cortical disease and primary pigmented nodular adrenocortical disease
10.3760/cma.j.cn112330-20250515-00206
- VernacularTitle:双侧大结节性肾上腺皮质病与原发性色素结节性肾上腺皮质病的临床特征分析
- Author:
Jiayang CHEN
1
;
Zhan WANG
1
;
Yushi ZHANG
1
Author Information
1. 中国医学科学院北京协和医学院北京协和医院泌尿外科，北京 100730
- Publication Type:Journal Article
- Keywords:
Adrenal cortex disease;
Bilateral;
Macronodular;
Primary pigmented nodular;
Cushing syndrome;
Clinical features;
Adrenalectomy
- From:
Chinese Journal of Urology
2025;46(7):512-516
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the clinical characteristics of bilateral nodular adrenal cortical disease（BmacAD）and primary pigmentary nodular adrenal cortical disease（PPNAD）.Methods:A retrospective analysis was conducted on the clinical records of 58 patients with BmacAD and 26 patients with PPNAD who were treated at Peking Union Medical College Hospital from January 2005 to December 2024. The clinical manifestations，endocrine examination，and surgical results between BmacAD patients and PPNAD patients were compared. Endocrine related examinations were reexamined 1 to 7 days and 15 to 30 days after the operation，and the recovery of cortisol within 30 days after the operation was recorded.Results:The male to female ratios of BmacAD patients and PPNAD patients were 31/27 and 11/15，with no statistically significant difference（ P > 0.05）. The age of BmacAD patients and PPNAD patients were 53.5（45.0，61.0）years and 19.0（15.8，24.0）years，respectively，with a statistically significant difference（ P < 0.001）. In terms of clinical manifestations，the proportion of BmacAD patients and PPNAD patients with Cushing syndrome appearance were 50.00%（29/58）and 96.15%（25/26），respectively，with a statistically significant difference（ P < 0.001）. There were no statistically significant differences between BmacAD and PPNAD patients in hypertension［87.93%（51/58）and 80.77%（21/26）］，abnormal glucose tolerance/diabetes［39.66%（23/58）and 34.62%（9/26）］and hypokalemia［18.97%（11/58）and 15.38%（4/26）］（ P > 0.05）. The difference in the proportion of osteopenia/osteoporosis /fracture between the two group was statistically significant［13.79%（8/58）and 53.85%（14/26）， P < 0.001］. In terms of hormone secretion，the median levels of 24-hour urinary free cortisol in BmacAD and PPNAD patients before surgery were 174.00（85.35，531.43）μg/24 h and 408.35（334.28，800.78）μg/24h（ P < 0.001），respectively. The proportion of preoperative plasma adrenocorticotropic hormone（ACTH）levels less than 5 pg/ml were 60.34%（35/58）and 84.62%（22/26）（ P < 0.05），respectively. Among the BmacAD patients 32 underwent unilateral total adrenalectomy，23 underwent unilateral partial adrenalectomy，and 3 underwent unilateral total adrenalectomy+contralateral partial adrenalectomy；the proportion of patients with increased preoperative cortisol secretion who recovered to normal within 30 days after surgery was 79.17%（38/48）. All 26 PPNAD patients underwent unilateral adrenalectomy. Within 30 days after surgery，68.00%（17/25）of the PPNAD patients had normal 24-hour urinary free cortisol levels. Conclusions:The cortisol secretion level in PPNAD patients is significantly higher than that in BmacAD patients，and the proportion of abnormal bone metabolism is higher. The short-term therapeutic efficacy of unilateral adrenalectomy or unilateral partial adrenalectomy is significant for both BmacAD and PPNAD.
