■伴有皮质醇共分泌的单侧原发性醛固酮增多症(UPA)的患病率在地理上有所不同。
■探讨UPA与皮质醇共分泌在中国人群中的患病率和临床特征。
■回顾性队列研究。
■我们招募了580例UPA患者,这些患者在1mg地塞米松抑制试验(DST)后接受了共促蛋白刺激试验(CST),并回顾性分析了有或无皮质醇分泌的UPA的临床特征和术后结局。
■在580名患者中的65名(11.2%)患者中发现了具有皮质醇共分泌的UPA(1mgDST>1.8ug/dL)。这些患者的特点是年龄较大,高血压持续时间较长,血浆醛固酮和午夜皮质醇浓度较高,降低促肾上腺皮质激素(ACTH)和硫酸脱氢表雄酮(DHEAS),肿瘤直径较大,和更多的糖尿病病史。CST后0-120分钟,皮质醇共分泌的UPA中皮质醇和醛固酮水平较高,DHEAS水平较低。342例UPA患者KCNJ5基因测序及随访结果,在皮质醇共分泌的UPA中,完全临床成功率较低(33.3%vs.56.4%,P<0.05);两组生化完全成功率和KCNJ5突变无差异。年龄,肿瘤大小,和ACTH是UPA与皮质醇共分泌的独立预测因子。性,BMI,高血压的持续时间,KCNJ5突变,和皮质醇共分泌是手术后UPA临床成功的独立预测因子。
■UPA与皮质醇共分泌在中国并不少见,但临床特征与无共分泌者明显不同。皮质醇共分泌是UPA手术后临床不完全成功的独立危险因素。
UNASSIGNED: The prevalence of unilateral primary aldosteronism (UPA) with cortisol co-secretion varies geographically.
UNASSIGNED: To investigate the prevalence and clinical characteristics of UPA with cortisol co-secretion in a Chinese population.
UNASSIGNED: Retrospective cohort study.
UNASSIGNED: We recruited 580 patients with UPA who underwent cosyntropin stimulation test (CST) after the 1-mg dexamethasone suppression test (DST) and retrospectively analyzed the clinical characteristics and postoperative outcomes of UPA with and without cortisol co-secretion.
UNASSIGNED: UPA with cortisol co-secretion (1 mg DST>1.8 ug/dL) was identified in 65 of 580 (11.2%) patients. These patients were characterized by older age, longer duration of hypertension, higher concentration of plasma aldosterone and midnight cortisol, lower adrenocorticotropic hormone (ACTH) and dehydroepiandrosterone sulfate (DHEAS), larger tumor diameter, and more history of diabetes mellitus. Cortisol and aldosterone levels were higher and DHEAS level was lower in UPA with cortisol co-secretion at 0-120 min after CST. Among 342 UPA patients with KCNJ5 gene sequencing and follow-up results, the complete clinical success rate was lower in UPA with cortisol co-secretion (33.3% vs. 56.4%, P<0.05); the complete biochemical success rate and KCNJ5 mutation did not differ between the two groups. Age, tumor size, and ACTH were independent predictors of UPA with cortisol co-secretion. Sex, BMI, duration of hypertension, KCNJ5 mutation, and cortisol co-secretion were independent predictors for complete clinical success in UPA after surgery.
UNASSIGNED: UPA with cortisol co-secretion is not uncommon in China, but the clinical features were distinctly different from those without co-secretion. Cortisol co-secretion is an independent risk factor for incomplete clinical success after surgery in UPA.