亚临床Cushing综合征的诊断及手术疗效分析  

Subclinical Cushing's syndrome:analysis of diagnosis and surgical effect

作　　者：冯超[1] 李汉忠[1] 肖河[1] 严维刚[1] 李永强[1] 徐维峰[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院泌尿外科,100730

出　　处：《中华外科杂志》2007年第24期1691-1693,共3页Chinese Journal of Surgery

摘　　要：目的对亚临床 Cushing 综合征临床症状及检测结果进行综合分析,提高亚临床Cushing 综合征的诊治水平。方法回顾性分析24例亚临床 Cushing 综合征患者的临床资料,并对患者手术前后的临床症状、生化指标及激素检测值进行对比分析。结果亚临床 Cushing 综合征24例,均无典型 Cushing 综合征的症状及体征。临床表现为高血压17例,血糖升高11例,高脂血症9例,血皮质醇节律消失13例,24 h 尿游离皮质醇升高9例。小剂量地塞米松抑制试验均末被抑制,大剂量地塞米松抑制试验16例未被抑制。CT 检查均发现。肾上腺肿瘤,肿瘤位于左侧者10例,位于右侧者14例,肿瘤直径平均为2.8 cm。所有患者均行腹腔镜肾上腺肿瘤切除术,病理为肾上腺皮质腺瘤。术后随访时间3个月～5年,其中20例(83.3%)患者术后临床症状、生化指标及激素水平检测较术前有显著改善,8例患者术后需行短期激素替代治疗。结论亚临床 Cushing 综合征应根据临床症状及检测结果综合分析作出诊断,血皮质醇、24 h 尿游离皮质醇检测、地塞米松抑制试验及 CT 检查对亚临床 Cushing 综合征的诊断有较大价值。手术治疗可改善患者临床症状,降低皮质激素水平,部分患者术后需短期激素替代治疗。对确诊为亚临床 Cushjng 综合征的患者,腹腔镜肾上腺肿瘤切除术应为首选治疗方法。Objective To improve the diagnostic and therapeutic ability on subclinical Cushing＇s syndrome. Methods Retrospective analysis for the clinical data of 24 cases of subclinical Cushing＇s syndrome, the clinical and biological charactors pre and post operation were compared. Results None of the 24 cases of subclinical Cushing＇s syndrome had the classic symptoms and signs of Cushing＇s syndrome. The common symptoms of these patients were hypertention in 17 cases, diabete mellitus in 11 cases, hyperlipidemia in 9 cases,high plasma cortisol value in 13 cases and high 24 h UFC value in 9 cases. None of patients did respond to low dose dexamethason suppression test, but 16 cases of them did not respond to high dose dexamethason suppression test. All the cases were found adrenal tumors by CT scan, 10 cases in left adrenal and 14 cases in right adrenal. All the patients underwent retroperitoneal laparoscopic operation and were pathologic diagnosised to adrenal adenomas. During follow-up, the symptoms of 20 cases（83.3% ） were cured after surgery, and hormone supplement was required in 8 cases. Conclusions Subclinical Cushing＇s syndrome may be incidentally detected on clinical manifestations, laboratory findings and imaging examinations. CT scan, assays of plasma cortisol, urinary free cortisol and dexamethasone suppression test are most useful in the diagnosis. The potential benefit of surgery should be considered in those who have a definite diagnosis of subclinical Cushing＇s syndrome. Hormone supplement is required in some patients. It is safe and practical to perform retropreitoneal laparoscopic surgery on the patients with subclinical Cushing＇s syndrome.

关 键 词：库欣综合征 诊断 治疗 腹腔镜手术 

分 类 号：R736.6[医药卫生—肿瘤]