Clinical Characteristics Of Various Types Of Cushing's Syndrome And Comparison Between Cortisol-producing Adenoma And Essential Hypertension

Objective To compare the general data,clinical manifestations and complications of various types of Cushing's syndrome(CS),analyze the clinical characteristics of special types of CS,and make gene analysis of primary bilateral macronodular adrenal hyperplasia,summarize rare clinical cases,improve the accuracy of diagnosis,and reduce the misdiagnosis rate and missed diagnosis rate of rare cases.To compare the clinical data of cortisol-producing adenoma and essential hypertension,and to evaluate the clinical diagnostic value of serum potassium,serum sodium,0am cortisol and 8am cortisol in differentiating cortisol-producing adenoma from essential hypertension.Methods 1.The patients with CS diagnosed in endocrinology ward from Junuary 2008 to December 2019 were retrospectively analyzed,including Cushing's disease(CD),ectopic ACTH syndrome(EAS),cortisol-producing adenoma(CPA),primary bilateral macronodular adrenal hyperplasia(PBMAH).CPA with hypertension and essential hypertension(EH)were compared.2.The general data,biochemical indexes,clinical manifestations,functional tests and imaging data of the patients were collected.3.The clinical data of ACTH-dependent and ACTH-independent Cushing's syndrome were compared,and the receiver operating characteristic(ROC)curves were drawn to explore the diagnostic efficiency of serum potassium,serum sodium,0am cortisol and 8am cortisol in CPA and EH.Results 1.(1)In Cushing's syndrome,exogenous accounted for 24.4%(29/119),endogenous accounted for 75.6%(90/119).CD and EAS in ACTH-dependent Cushing's syndrome accounted for 21.8%(26/119)and 4.2%(5/119)respectively.CPA and PBMAH in ACTH-independent Cushing's syndrome accounted for 37.0%(44/119)and 12.6%(15/119)respectively.The most common clinical manifestations were hypertension(73.9%),Moonfacies(63.0%)and abnormal glucose metabolism(58.0%).(2)group CD and group EAS:the age in group CD(35.69�10.50)was younger than that in group EAS(49.00�9.06),LDL(3.05�0.88)was lower than group EAS(4.07�1.02).0am cortisol(491.64�251.83)was lower than that in group EAS(1036.85�374.50),HDDST cortisol(167.45�128.61)was lower than group EAS(889.99�369.45).(3)group CPA and group PBMAH: The proportion of women in group CPA(86.4%)was higher than that in group PBMAH(53.3%).The age of group CPA(44.77�12.09)was younger than that of group PBMAH(57.73�13.31),The course of hypertension in CPA group[2.00(0,6.00)]was shorter than that in group PBMAH[8.00(3.00,10.00)].0am cortisol(400.67�171.68)was higher than that in group PBMAH(195.58�117.83).LDDST cortisol(441.67�203.56)was higher than that in group PBMAH(166.50�79.07).HDDST cortisol(438.26�179.07)was higher than that in group PBMAH(186.63�151.34).(4)group CD and group CPA: the age of patients in group CD(35.69�10.50)was younger than that in group CPA(44.77�12.09),BMI(23.31�1.77)was lower than group CPA(25.72�3.21),e GFR(121.13�53.47)was higher than group CPA(97.05�24.27),8am cortisol in group CD(620.23�232.19)was higher than that in group CPA(436.54�202.67),HDDST cortisol(167.45�128.61)was lower than that in group CPA(438.26�179.07).(5)The typical adrenal CT in patients with PBMAH is bilateral macronodular adrenal hyperplasia,and the pathogenic mutant gene of ARMC5 is found in the patients.(6)The clinical manifestations of subclinical Cushing's syndrome were not typical.Patients were diagnosed mainly due to hypertension,diabetes and other atypical symptoms.2.(1)group CPA and group EH: The proportion of women in group CPA(86.5%)was higher than that in group EH(51.6%),and the age(46.38�10.92)was younger than that in group EH(54.73�11.70).The highest SBP in group CPA(178.97�24.71)was higher than that in group EH(170.96�21.53).The course of hypertension in group CPA[3.00(0.29,8.50)]was shorter than that in group EH[6.00(3.00,13.00)].TC in group CPA(5.50�1.82)was higher than that in group EH(4.88�1.01),HDL(1.28�0.41)is higherthan group EH(1.09�0.26),Serum sodium(142.43�3.19)was higher than that in group EH(139.77�3.54),0am cortisol(400.67�171.68)was higher than group EH(89.28�79.86),8am cortisol(426.41�194.31)was higher than group EH(295.13�112.06),LDDST cortisol(439.46�200.14)was higher than group EH(33.16�21.32).(2)the ROC curves of serum potassium,serum sodium,0am cortisol and 8am cortisol were drawn with the group EH as the control group.The AUC of midnight 0am cortisol was 0.959,and the best cut point was 133.9nmol/L,with a sensitivity of 93.94% and a specificity of 82.80%.Conclusion 1.Through the analysis and differential analysis of the clinical characteristics of various types of Cushing's syndrome,it provides an important reference basis for how to find out Cushing's syndrome in hypertension as much as possible.2.For hypertensive patients with atypical manifestations such as only abnormal glucose metabolism or short course of disease,routine screening should be carried out to avoid missed the diagnosis of subclinical Cushing's syndrome.Routine determination of cortisol rhythm provides clues for diagnosis.3.Imaging CT of adrenal macronodular hyperplasia provides important assistance for clinical diagnosis.Patients with pathogenic gene mutations are advised to further check and genetic counseling in order to find the disease and choose appropriate treatment.4.Midnight 0am cortisol higher than 133.9nmol/L can be used as an important basis for distinguishing cortisol-producing adenoma from essential hypertension.