肾上腺醛固酮-皮质醇共分泌瘤七例临床分析

发布时间：2018-05-25 19:15

本文选题：肾上腺疾病 + 醛固酮增多症　；参考：《中国全科医学》2017年24期

【摘要】：目的回顾性分析7例肾上腺醛固酮-皮质醇共分泌瘤(A/CPA)患者的临床特点,并进行相关文献复习,以提高对该病的认识和诊疗水平。方法回顾性收集2010—2016年中国人民解放军总医院收治的7例A/CPA患者的临床资料。总结并分析A/CPA患者的一般情况、一般资料、治疗及随访情况。结果 7例A/CPA患者中男1例,女6例;平均就诊年龄(49.1±12.8)岁;体质指数21.5~28.5 kg/m~2;平均肾上腺肿瘤最大直径(3.4±1.6)cm。7例患者均进行血浆醛固酮水平与血浆肾素活性比值(ARR)测定,且均≥25;卡托普利试验和/或生理盐水输注试验结果支持PA诊断。所有患者无典型库欣综合征临床表现,血清皮质醇昼夜节律紊乱,过夜1 mg地塞米松抑制试验或经典小剂量地塞米松抑制试验结果支持亚临床库欣综合征诊断。6例患者术后病理提示为肾上腺皮质腺瘤。术后2例患者出现乏力、食欲不振,其中患者1复查血浆醛固酮水平、血清皮质醇水平明显降低,予泼尼松替代治疗5个月。结论对于肾上腺肿瘤直径2.0 cm的APA患者,需警惕合并亚临床库欣综合征的可能。术前应完善相关内分泌激素水平测定以明确诊断,术后根据临床症状和激素水平以判定是否需予以糖皮质激素替代治疗。
[Abstract]:Objective to retrospectively analyze the clinical features of 7 cases of adrenal aldosterone-cortisol cosecretory tumor A / CPA and review the relevant literature to improve the understanding and diagnosis and treatment of the disease. Methods the clinical data of 7 patients with A/CPA from 2010 to 2016 in PLA General Hospital were retrospectively collected. To summarize and analyze the general situation, general data, treatment and follow-up of A/CPA patients. Results there were 1 male and 6 female patients with A/CPA. The mean age was 49.1 卤12.8years, the BMI was 21.5 ~ 28.5 kg / m ~ (2), the mean maximum diameter of adrenal tumor was 3.4 卤1.6)cm.7, the plasma aldosterone level and the ratio of plasma renin activity were measured. The results of captopril test and / or saline infusion test supported the diagnosis of PA. All the patients had no typical clinical manifestation of Cushing's syndrome, and the circadian rhythm of serum cortisol was disorder. The results of overnight 1 mg dexamethasone inhibition test or classic low dose dexamethasone inhibition test supported the diagnosis of subclinical Cushing's syndrome in 6 patients with adrenal cortical adenoma. Two patients developed fatigue and anorexia after operation. Patients 1 reexamined the plasma aldosterone level and the serum cortisol level decreased significantly and received prednisone replacement therapy for 5 months. Conclusion for APA patients with adrenal tumor diameter 2.0 cm, the possibility of subclinical Cushing syndrome should be observed. Preoperative endocrine hormone levels should be improved to make a clear diagnosis, and glucocorticoid replacement therapy should be given after surgery according to the clinical symptoms and hormone levels in order to determine whether glucocorticoid replacement therapy is necessary.
【作者单位】：中国人民解放军总医院内分泌科;海南省人民医院内分泌科;
【分类号】：R586.24

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