病例报告

亚临床原发性醛固酮增多症合并亚临床库欣综合征1例并文献复习

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  • 1.山东第二医科大学临床医学院,山东 潍坊 261000
    2.山东大学齐鲁医院德州医院全科医学科,山东 德州 253000
王敏 E-mail:wmrmyy@163.com

收稿日期: 2023-09-04

  网络出版日期: 2024-03-15

A case report of subclinical primary aldosterone complicating with subclinical Cushing syndrome and literature review

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  • 1. School of Clinical Medicine, Shandong Second Medical University, Shandong Weifang 261000, China
    2. Qilu Hospital of Shandong University, Dezhou Hospital, Department of General Medicine, Shandong Dezhou 253000, China

Received date: 2023-09-04

  Online published: 2024-03-15

摘要

本文报告1例罕见的亚临床原发性醛固酮增多症(subclinical primary aldosteronism,SPA)合并亚临床库欣综合征(subclinical Cushing syndrome,SCS)患者。该患者为41岁的女性,因肾上腺偶发瘤(adrenal incidentaloma,AI)入院。患者无高血压、低血钾、糖代谢异常等典型的原发性醛固酮增多症(primary aldosteronism,PA)或库欣综合征(Cushing syndrome,CS)的临床表现,实验室检查示醛固酮肾素比值(aldosterone to renin ratio,ARR)>3.7,促肾上腺皮质激素(adrenocorticotropic hormone,ACTH)<1.6 pg/mL,最终依据术后病理学检查结果,患者被诊断为肾上腺皮质腺瘤。该病例中存在2种亚临床疾病共存的诊断,这种临床类型在目前的指南和报道中并未得到充分认识,值得关注并进行更详细的讨论。

本文引用格式

侯怡茹, 王敏, 王春花, 陈俞洁 . 亚临床原发性醛固酮增多症合并亚临床库欣综合征1例并文献复习[J]. 诊断学理论与实践, 2023 , 22(05) : 480 -485 . DOI: 10.16150/j.1671-2870.2023.05.010

Abstract

This case reports a rare subclinical primary aldosteronism complicated with subclinical Cushing’s syndrome. A 41-year-old female patient was admitted for adrenal incidentaloma, had no clinical manifestations of typical primary aldosteronism or Cushing syndrome, such as hypertension, hypokalemia, abnormal glucose metabolism. Laboratory tests indicated ARR> 3.7, ACTH <1.6 pg/mL, and a postoperative pathological diagnosis was adrenal cortical adenoma. Subclinical coexistence of both diseases was presented in this case. This type is not fully recognized in current guidelines and reports, and deserves more detailed discussion.

参考文献

[1] ITO Y, TAKEDA R, TAKEDA Y. Subclinical primary aldosteronism[J]. Best Pract Res Clin Endocrinol Metab, 2012, 26(4):485-495.
[2] 宋颖, 何文雯, 冯正平, 等. 血压正常的原发性醛固酮增多症临诊应对[J]. 中华内分泌外科杂志, 2023, 17(3):376-377.
  SONG Y, HE W W, FENG Z P, et al. Approach to a normotensive patient with primary aldosteronism[J]. Chin J Endoc Surg, 2023, 17(3):376-377.
[3] 白求恩精神研究会内分泌和糖尿病学分会《2022年亚临床库欣综合征专家指导建议》编写组. 2022年亚临床库欣综合征专家指导建议[J]. 国际内分泌代谢杂志, 2023, 43(1):69-76.
  Expert group for "Expert consensus on subclinical Cus-hing′s syndrome in China(2022)". Expert consensus on subclinical Cushing′s syndrome in China (2022)[J]. Int J Endocrinol Metab, 2023, 43(1):69-76.
[4] FAVERO V, CREMASCHI A, PARAZZOLI C, et al. Pathophysiology of mild hypercortisolism: from the bench to the bedside[J]. Int J Mol Sci, 2022, 23(2):673.
[5] FAVERO V, CREMASCHI A, FALCHETTI A, et al. Management and medical therapy of mild hypercortisolism[J]. Int J Mol Sci, 2021, 22(21):11521.
[6] CHIODINI I, ALBANI A, AMBROGIO A G, et al. Six controversial issues on subclinical Cushing's syndrome[J]. Endocrine, 2017, 56(2):262-266.
[7] 王冬, 王若秋, 朱兴艳, 等. 肾上腺醛固酮-皮质醇共分泌瘤2例报道并文献复习[J]. 国际内分泌代谢杂志, 2023, 43(5):418-421.
  WANG D, WANG R Q, ZHU X Y, et al. Adrenal aldosterone and cortisol co-producing adenoma: Two cases report and literature review[J]. Int J Endocrinol Metab, 2023, 43(5):418-421.
[8] KITAJIMA N, SEKI T, YASUDA A, et al. A rare case of subclinical primary aldosteronism and subclinical Cus-hing's syndrome without cardiovascular complications[J]. Tokai J Exp Clin Med, 2016, 41(1):35-41.
[9] ICHIJO T, UESHIBA H, NAWATA H, et al. A nationwide survey of adrenal incidentalomas in Japan: the first report of clinical and epidemiological features[J]. Endocr J, 2020, 67(2):141-152.
[10] PAN L H, CHEN Y Y, PAN C T, et al. Follow-up care and assessment of comorbidities and complications in patients with primary aldosteronism: The clinical practice guideline of the Taiwan Society of aldosteronism[J/OL]. J Formos Med Assoc, 2023-08-22. https://linkinghub.elsevier.com/retrieve/pii/S0929-6646(23)00324-8.
[11] 中华医学会内分泌学分会. 原发性醛固酮增多症诊断治疗的专家共识(2020版)[J]. 中华内分泌代谢杂志, 2020, 36(9):727-736.
  Chinese Society of Endocrinology. Expert consensus on the diagnosis and treatment of primary aldosteronism (2020)[J]. Chin J Endocrinol Metab, 2020, 36(9):727-736.
[12] 中国内分泌代谢病专科联盟. 原发性醛固酮增多症诊治行业标准[J]. 中华内分泌代谢杂志, 2022, 38(7):555-557.
  China Endocrinology and Metabolism Specialist Alliance. Standard for the diagnosis and treatment of primary aldosteronism[J]. Chin J Endocrinol Metab, 2022, 38(7):555-557.
[13] KMIE? P, SWORCZAK K. Autonomous aldosterone secretion as a subclinical form of primary aldosteronism: pathogenesis and clinical significance[J]. Exp Clin Endocrinol Diabetes. 2022 Jan; 130(1):7-16.
[14] FASSNACHT M, ARLT W, BANCOS I, et al. Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the study of adrenal tumors[J]. Eur J Endocrinol, 2016, 175(2):G1-G34.
[15] YANASE T, OKI Y, KATABAMI T, et al. New diagnostic criteria of adrenal subclinical Cushing's syndrome: opinion from the Japan Endocrine Society[J]. Endocr J, 2018, 65(4):383-393.
[16] YOUNG W F. Primary aldosteronism: renaissance of a syndrome[J]. Clin Endocrinol (Oxf), 2007, 66(5):607-618.
[17] STOWASSER M, GORDON R D. Primary aldosteronism-careful investigation is essential and rewarding[J]. Mol Cell Endocrinol, 2004, 217(1-2):33-39.
[18] MOSSO L, CARVAJAL C, GONZáLEZ A, et al. Primary aldosteronism and hypertensive disease[J]. Hypertension, 2003, 42(2):161-165.
[19] BROWN J M, ROBINSON-COHEN C, LUQUE-FERNANDEZ M A, et al. The spectrum of subclinical primary aldosteronism and incident hypertension: a cohort study[J]. Ann Intern Med, 2017, 167(9):630-641.
[20] KMIE? P, ZALEWSKA E, KUNICKA K, et al. Autonomous aldosterone secretion in patients with adrenal incidentaloma[J]. Biomedicines, 2022, 10(12):3075.
[21] 李乐乐, 韩白玉, 窦京涛, 等. 午夜1 mg地塞米松抑制试验对肾上腺意外瘤中亚临床库欣综合征的诊断价值[J]. 中华医学杂志, 2015, 95(48):3912-3916.
  LI L L, HAN B Y, DOU J T, et al. Evaluation of the 1 mg overnight dexamethasone suppression test in the diagnosis of the subclinical Cushing's syndrome in patients with adrenal incidentaloma[J]. Natl Med J China, 2015, 95(48):3912-3916.
[22] OJEDA N B, GRIGORE D, ROBERTSON E B, et al. Estrogen protects against increased blood pressure in postpubertal female growth restricted offspring[J]. Hypertension, 2007, 50(4):679-685.
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