| Objective:To analyze and summarize the clinical and metabolic characteristics and hormone levels of patients with Subclinical Cushing’s syndrome,and to explore the possible risk factors of metabolic abnormalities in SCS patients and the correlation between metabolic indicators and cortisol levels.Methods:A total of 56 patients with Subclinical Cushing’s syndrome who were diagnosed and treated in the Department of Endocrinology,Affiliated Drum Tower Hospital of Nanjing University Medical College from March 2010 to October 2018,68 patients with adrenal adenoma type overt Cushing’s syndrome(CS)and 56 patients with adrenal non-functional tumor(NFA)who matched SCS gender,age,and BMI.Compare clinical data,metabolic characteristics and hormone levels,compare the clinical features of patients with different metabolic status of SCS,and further analyze the correlation between cortisol levels and metabolic indicators.Results:(1)The average age of SCS patients was 52.04±12.58 years old,of which women accounted for 73.2%.The incidence of hypertension,abnormal glucose metabolism,abnormal lipid metabolism,and osteopenia/osteoporosis was significantly higher in patients with SCS than in patients with non-functional tumors(75%vs.41.1%,33.9%vs.12.50%).62.5%vs.28.6%,45.5%vs.8.9%:P<0.05).The incidence of metabolic abnormalities in patients with SCS was lower than that in patients with CS,but there was no significant difference(P>0.05).Body composition analysis showed that the fat content and fat percentage of SCS patients were significantly higher than NFA,while the muscle content was significantly lower(P<0.05).The ratio of trunk to body fat in CS group was higher than that in the other two groups.The fat ratio of extremity and whole body was lower than the other two groups,and there were statistical differences(P<0.05).(2)Plasma ACTH in patients with SCS compared with NFA patients,the levels were lower(P<0.05),while cortisol levels were higher at night cortisol levels and 1 mg dexamethasone(P<0.05).There was no significant difference between the two 24-hour urinary free cortisol and early morning cortisol levels(P>0.05).Compared with SCS,ACTH-cortisol axis disorder was more prominent in CS patients,with lower plasma ACTH levels and higher plasma and 24h urinary cortisol levels;(3)SCS patients were compared according to the combined metabolic abnormalities.SCS patients with multiple metabolic abnormalities(>3)had higher age and BMI,and creatinine clearance was lower(P<0.05).(4)SBP,FBG,HbA1c were positively correlated with 24h-UFC in SCS patients(r 0.335,0.562 and 0.483,P is 0.026,<0.001 and 0.002,respectively.There was still a significant correlation(P<0.05)in the correction of age and gender.Conclusions:(1)There is autonomous cortisol secretion in patients with subclinical syndrome,and the incidence of metabolic abnormalities is increased;(2)Age,increased BMI levels.and decreased creatinine clearance are risk factors for metabolic complications in patients with SCS.Blood glucose and blood pressure are more correlated with cortisol levels than other metabolic indicators.Objective:To analyze the changes of metabolic parameters in patients with Subclinical Cushing’s syndrome after different management.For patients undergoing surgery,the changes in postoperative metabolic parameters were compared according to different metabolic status before surgery to explore the largest benefit group for surgical treatment.Methods:Thirty-one patients with unilateral adrenalectomy who underwent complete follow-up data were included in the study.Eleven patients with complete follow-up data were included.The clinical characteristics of SCS patients with different treatment methods were compared,and the metabolic indicators and hormone levels were followed up.The surgical patients were further divided according to the preoperative combined metabolic abnormalities,and the improvement of postoperative metabolic indexes was compared.Results:(1)The ACTH-F axis was abnormally corrected after SCS treatment.There were no significant changes in ACTH and cortisol abnormalities during the follow-up period.(2)The weight,BMI,systolic blood pressure and diastolic blood pressure of the operation group were significantly lower than those before operation(P<0.05).Postoperative TC and LDL levels decreased and there was a statistical difference(P<0.05).Body weight,BMI,systolic and diastolic blood pressure,HbAlc,FBG,TG,TC and LDL were not significantly changed in the unoperated group(P>0.05),and the waist circumference was slightly increased(P<0.05).In the surgical group,36.4%of overweight/obese patients returned to normal weight after surgery.54.5%of hypertensive patients were cured or relieved after surgery.60%of patients with abnormal glucose metabolism before surgery improved to some extent.The proportion of patients with metabolic abnormalities such as overweight or obesity,abnormal glucose metabolism,and hypertension in the unoperated group had no significant change from baseline.(3)According to the preoperative combined metabolic abnormal state,the surgical treatment patients were grouped,and the improvement of postoperative metabolic index was compared.There were no significant changes in postoperative weight,blood pressure,blood glucose and other metabolic indicators in patients with no metabolic abnormalities before surgery.Postoperative weight and blood pressure were significantly lower in patients with mild and significant metabolic abnormalities than before surgery,and there was a statistical difference(P<0.05).Conclusions:(1)ACTH-F axis abnormalities were corrected after SCS patients underwent surgical treatment.There was no significant change in the ACTH-F axis function in the unoperated group;(2)the postoperative metabolic abnormalities were improved to some extent in the surgically treated patients,and the metabolic index did not significantly improve or aggravate during the follow-up period.Patients with metabolic abnormalities benefited more significantly after surgery,and the improvement in body weight and blood pressure was more prominent. |
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