Comparison and analysis of clinical features of benign adrenal Cushing syndrome
MIAO Xin-yu
LIN Lu
LI Le-le
DOU Jing-tao
CHEN Kang
LYU Zhao-hui
Ba Jian-ming
PEI Yu
GU Wei-jun
DU Jin
GUO Qing-hua
WANG Xian-ling
ZANG Li
LI Yi-jun
YAN Wen-hua
LI Chun-lin
MU Yi-ming
Abstract：Objective To provide a clinical basis for differential diagnosis,clinical features of Adrenocortical adenoma(ADA),bilateral macronodular adrenal hyperplasia(BMAH)and primary pigmented nodular adrenocortical disease(PPNAD)with overt Cushing syndrome were compared.Methods The clinical data of inpatients with confirmed ADA(n=86),BMAH(n=23)and PPNAD(n=7)were analyzed retrospectively from 2008 to 2020 in Chinese PLA General Hospital.Results 1.Patients in BMAH were the oldest with the average age(51.7±9.5)years,and patients in PPNAD group were the youngest with the average age of(19.9±5.7)years.There were more female patients in ADA and PPNAD groups,whereas the proportion of males to females in BMAH group was approximately equal.2.Clinical presentation:Purple striae(71.4％)were more common in PPNAD group,but there were no statistically differences in the presence of facial plethora,easy bruising,moon face,central obesity,and skin thinning among the three groups.3.Metabolic complications:Hyperglycemia and lipid disorders in the BMAH group were more common(87.0％and 68.2％,respectively),and the percentage of low bone mass or osteoporosis were all high in the three groups(＞75％).Systolic pressure,Glycated hemoglobin A1c,triglyceride,and serum sodium were higher in BMAH group(P＜0.05),compared with other two groups.In addition,all three groups presented marked insulin resistance according to HOMA-IR.4.ACTH and cortisol(F)levels:The baseline ACTH levels of the three groups were inhibited,and serum F and 24 h UFC levels increased in all three groups(P＞0.05).In patients with PPNAD,the 24 h UFC levels significantly elevated after low-dose dexamethasone suppression test(LDDST)and high-dose dexamethasone suppression test(HDDST)(all P＜0.05),compared with baseline 24 h UFC levels.Conclusion In benign overt adrenal Cushing syndrome,patients with BMAH are older and have more metabolic disorders,whereas patients with PPNAD are younger.The elevated 24 h UFC levels after LDDST and HDDST are useful for identifying PPNAD.
Keywords：Cushing syndromeACTH-independentadrenocortical adenomabilateral macronodular adrenal hyperplasiaprimary pigmented nodular adrenocortical disease
Publication Date：2024-02-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：6( 134-139 )