目的:为了研究临床,双侧和单侧大结节轻度自主皮质醇分泌(MACS)患者的磁共振成像(MRI)的实验室发现和信号强度指数(SII)。
方法:从回顾性记录中检查81例MACS患者的临床和实验室检查结果。通过MRI评估腺瘤和结节间区域的SII。单侧组包括单个肾上腺的肾上腺大结节(≥1厘米)的患者,而双侧组包括两个肾上腺至少有一个大结节的患者。
结果:总计,46例患者为单侧(57%),35例(43%)患者在双侧组中。单侧组的硫酸脱氢表雄酮(DHEA-S)水平低于双侧组(p<.001)。2型糖尿病(T2DM)的存在,双侧组糖化血红蛋白(HbA1c)和低密度脂蛋白(LDL)浓度较高(p<0.05)。然而,促肾上腺皮质激素(ACTH)和1mg地塞米松抑制试验(DST)在两组间无显著差异(p>.05).同一患者腺瘤之间的SII没有差异,以及单边和双边组之间(p>.05)。基于单侧和双侧大结节MACS之间差异的Logistic回归分析表明DHEA-S,HbA1c和LDL浓度是相关因素。
结论:与单侧腺瘤患者相比,双侧大结节性MACS患者的DHEA-S水平可能没有受到抑制。在双侧患者中,T2DM和高胆固醇血症的发生频率更高。然而,ACTH,隔夜1mgDST和SII可能无法提供区分双边性和单边性的其他信息。
OBJECTIVE: To investigate the clinical, laboratory findings and signal intensity index (SII) on magnetic resonance imaging (MRI) of patients with bilateral and unilateral macronodular mild autonomous cortisol secretion (MACS).
METHODS: Clinical and laboratory findings of 81 patients with MACS were examined from retrospective records. SII of adenomas and internodular areas were evaluated by MRI. The unilateral group included patients with an adrenal macronodule (≥1 cm) in a single adrenal gland, while the bilateral group included patients with at least one macronodule in both adrenal glands.
RESULTS: In total, 46 patients were in the unilateral (57%), while 35 (43%) patients were in the bilateral groups. The dehydroepiandrosterone sulphate (DHEA-S) level was lower in the unilateral than in the bilateral group (p < .001). The presence of type 2 diabetes mellitus (T2DM), glycosylated haemoglobin (HbA1c) and low-density lipoprotein (LDL) concentrations were higher in the bilateral group (p < .05). However, no significant difference was detected in terms of adrenocorticotropic hormone (ACTH) and overnight 1 mg dexamethasone suppression test (DST) between the two groups (p > .05). There was no difference in SII between adenomas within the same patient, as well as between the unilateral and bilateral groups (p > .05). Logistic regression analysis based on the differentiation between unilateral and bilateral macronodular MACS demonstrated that DHEA-S, HbA1c and LDL concentrations were associated factors.
CONCLUSIONS: DHEA-S levels may not be as suppressed in patients with bilateral macronodular MACS as compared to those with unilateral adenoma. T2DM and hypercholesterolaemia have a higher frequency in bilateral patients. However, ACTH, overnight 1 mg DST and SII may not provide additional information for differentiation of bilaterality and unilaterality.