轻微自主皮质醇分泌的临床特点及诊疗进展  

Clinical features and progress in diagnosis and treatment of mild autonomous cortisol secretion

作　　者：王士铭 范维伟 金嘉成 郝心晴 王建伯[1] Wang Shiming;Fan Weiwei;Jin Jiacheng;Hao Xinqing;Wang Jianbo(Department of Urology,The First Affiliated Hospital of Dalian Medical University,Dalian 116011,China;Stem Cell Clinical Research Center,The First Affiliated Hospital of Dalian Medical University,Dalian 116011,China)

机构地区：[1]大连医科大学附属第一医院泌尿外科,大连116011 [2]大连医科大学附属第一医院干细胞临床研究中心,大连116011

出　　处：《中华泌尿外科杂志》2024年第4期325-328,共4页Chinese Journal of Urology

摘　　要：轻微自主皮质醇分泌(MACS)是一种缺乏库欣综合征典型体征(如满月脸、水牛背、多血质貌、皮肤紫纹等),但生化指标仍能检测出皮质醇自主分泌的综合征。其在中年女性中多发,常见于肾上腺意外瘤。由于缺乏显著临床体征,MACS的诊断主要依赖激素检查。MACS患者常伴有高血压、糖尿病、骨质疏松等合并症。针对有合并症的MACS患者主要的治疗方式为手术治疗。本文对近年国内外相关指南和研究进行综述,以阐明MACS诊断标准的更新内容,尤其是关于1mg过夜地塞米松抑制试验结果的解读,并阐述了MACS的治疗和随访策略。此外,本文指出,未来呕需开展更多大规模的前瞻性研究,以完善现有的诊断标准并制订适用于更广泛MACS患者群体的手术指南。Mild autonomous cortisol secretion(MACS)is a condition indicated by biochemical testing for autonomous cortisol secretion,yet it lacks the classical signs of Cushings Syndrome,such as moon face,buffalo hump,plethoric appearance,and purple striae.It is predominantly observed in middle-aged women and is commonly associated with adrenal incidentalomas.Due to the lack of significant clinical signs,the diagnosis of MACS primarily relies on hormonal testing.Patients with MACS often present with comorbidities such as hypertension,diabetes,and osteoporosis.For those with comorbid conditions,surgical treatment is the principal therapeutic approach.This article summarizes recent national and international guidelines and research to elucidate the updates to the diagnostic criteria for MACS,with a particular focus on the interpretation of the 1 mg overnight dexamethasone suppression test results.It also details the treatment and follow-up strategies for MACS.Furthermore,the article highlights the urgent need for more extensive prospective studies to refine the existing diagnostic criteria and to develop surgical guidelines for a wider range of patients with MACS.

关 键 词：亚临床库欣综合征 轻微自主皮质醇分泌 皮质醇增多 肾上腺 肾上腺意外瘤 

分 类 号：R736.6[医药卫生—肿瘤]