The Clinical Research Of Severe Adrenal Cushing's Syndrome

Objective: Part I To investigate the diagnostic criteria and clinical features of severe adrenal Cushing's syndrome.Part II To investigate the methods and efficacy of treatment on severe adrenal Cushing's syndrome.Methods: The clinical data of 22 cases with severe adrenal Cushing's syndrome(severe group),and 136 cases with mild or moderate adrenal Cushing's syndrome(non-severe group)were reviewed.Part I The clinical features were analyzed by comparing the differences between the two groups when patients were admitted to hospital.Part II We discussed the clinical managements of patients with severe adrenal Cushing's syndrome by comparing the differences with non-severe group after preoperative preparation,and with themselves before and after preoperative preparation.The effects of surgery were evaluated by comparing the differences between pre-operation and post-operation on patients with severe adrenal Cushing's syndrome.Results: Part I Serum cortisol,clinical course and blood pressure were significantly higher in the severe group than those in non-severe group.Serum potassium and ACTH content were significantly decreased in the severe group.Part II No significant difference was observed in diastolic pressure,serum potassium and fasting plasma glucose between the two groups after preoperative preparation.And then,we performed adrenalectomy.The symptoms of 22 cases with severe adrenal Cushing's syndrome were obviously alleviated after 3 months.During follow-up,5 cases of PBMAH and 1 case of PPNAD were treated with contralateral adrenalectomy.Conclusion: Sufficient preoperative preparation is essential for patients with severe adrenal Cushing's syndrome because of high level of serum cortisol and severe complications.Severe patients with PBMAH and PPNAD were firstly performed unilateral adrenalectomy and closely followed-up,and then,contralateral adrenalectomy is needed when the recurrence of hypercortisolism recognized.