Abstract：
OBJECTIVE: Benign adrenocortical tumours are diagnosed in ∼5% of adults and are associated with cortisol excess in 30%-50% of cases. Adrenal Cushing\'s syndrome (CS) is rare and leads to multiple haematological alterations. However, little is known about the effects of the much more frequent mild autonomous cortisol secretion (MACS) on immune function. The aim of this study was to evaluate the haematological alterations in benign adrenocortical tumours with different degrees of cortisol excess.
METHODS: We investigated 375 patients: 215 with non-functioning adrenal tumours (NFAT), 138 with MACS, and 22 with CS. We evaluated the relationship between the degree of cortisol excess and full blood count as well as multiple inflammation-based scores, including the neutrophil-to-lymphocyte ratio (NLR), the lymphocyte-to-monocyte ratio (LMR), and the systemic immune-inflammation index (SII).
RESULTS: We observed a gradual and significant increase of leucocytes, neutrophils, and monocytes across the spectrum of cortisol excess, from NFAT over MACS to CS. Neutrophil-to-lymphocyte ratio and SII were significantly higher in both MACS and CS when compared to NFAT (P < .001 and P = .002 for NLR and P = .006 and P = .021 for SII, respectively). Conversely, LMR was lower in MACS and CS than in NFAT (P = .01 and <.001, respectively) but also significantly lower in CS compared to MACS (P = .007).
CONCLUSIONS: Neutrophil-to-lymphocyte ratio, SII, and LMR correlated with the degree of cortisol excess in benign adrenocortical tumours and were altered in patients with CS and MACS. These findings suggest that, similar to clinically overt CS, MACS also affects the immune function, potentially contributing to the MACS-associated comorbidities.
METHODS: We investigated 375 patients: 215 with non-functioning adrenal tumours (NFAT), 138 with MACS, and 22 with CS. We evaluated the relationship between the degree of cortisol excess and full blood count as well as multiple inflammation-based scores, including the neutrophil-to-lymphocyte ratio (NLR), the lymphocyte-to-monocyte ratio (LMR), and the systemic immune-inflammation index (SII).
RESULTS: We observed a gradual and significant increase of leucocytes, neutrophils, and monocytes across the spectrum of cortisol excess, from NFAT over MACS to CS. Neutrophil-to-lymphocyte ratio and SII were significantly higher in both MACS and CS when compared to NFAT (P < .001 and P = .002 for NLR and P = .006 and P = .021 for SII, respectively). Conversely, LMR was lower in MACS and CS than in NFAT (P = .01 and <.001, respectively) but also significantly lower in CS compared to MACS (P = .007).
CONCLUSIONS: Neutrophil-to-lymphocyte ratio, SII, and LMR correlated with the degree of cortisol excess in benign adrenocortical tumours and were altered in patients with CS and MACS. These findings suggest that, similar to clinically overt CS, MACS also affects the immune function, potentially contributing to the MACS-associated comorbidities.
摘要：
目的：良性肾上腺皮质肿瘤在大约5％的成年人中被诊断，并且在30-50％的病例中与皮质醇过量相关。肾上腺库欣综合征（CS）很少见，可导致多种血液学改变。然而,关于更频繁的轻度自主皮质醇分泌（MACS）对免疫功能的影响知之甚少。这项研究的目的是评估皮质醇过量程度不同的良性肾上腺皮质肿瘤的血液学改变。
方法：我们调查了375例患者：215例无功能性肾上腺皮质肿瘤（NFAT），138与MACS，和22与CS。我们评估了皮质醇过量程度与全血细胞计数以及多个基于炎症的评分之间的关系，包括中性粒细胞与淋巴细胞比率（NLR），淋巴细胞与单核细胞的比率（LMR），和全身免疫炎症指数（SII）。
结果：我们观察到白细胞逐渐显著增加，中性粒细胞，皮质醇过量的单核细胞，从NFAT通过MACS到CS。与NFAT相比，MACS和CS中的NLR和SII均显着较高（NLR的p<0.001和p=0.002，SII的p=0.006和p=0.021，分别)。相反，MACS和CS的LMR低于NFAT（分别为p=0.01和<0.001），但与MACS相比，CS也显着降低（p=0.007）。
结论：NLR，SII和LMR与良性肾上腺皮质肿瘤中皮质醇过量的程度相关，并且在CS和MACS患者中发生了改变。这些发现表明,与临床上明显的CS相似，MACS还会影响免疫功能，可能导致MACS相关的合并症。
方法：我们调查了375例患者：215例无功能性肾上腺皮质肿瘤（NFAT），138与MACS，和22与CS。我们评估了皮质醇过量程度与全血细胞计数以及多个基于炎症的评分之间的关系，包括中性粒细胞与淋巴细胞比率（NLR），淋巴细胞与单核细胞的比率（LMR），和全身免疫炎症指数（SII）。
结果：我们观察到白细胞逐渐显著增加，中性粒细胞，皮质醇过量的单核细胞，从NFAT通过MACS到CS。与NFAT相比，MACS和CS中的NLR和SII均显着较高（NLR的p<0.001和p=0.002，SII的p=0.006和p=0.021，分别)。相反，MACS和CS的LMR低于NFAT（分别为p=0.01和<0.001），但与MACS相比，CS也显着降低（p=0.007）。
结论：NLR，SII和LMR与良性肾上腺皮质肿瘤中皮质醇过量的程度相关，并且在CS和MACS患者中发生了改变。这些发现表明,与临床上明显的CS相似，MACS还会影响免疫功能，可能导致MACS相关的合并症。
