[1]白求恩精神研究会内分泌和糖尿病学分会《0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(01):69-76.[doi:10.3760/cma.j.cn121383-20220930-09061]
　Expert group for Expert consensus on subclinical Cushing's syndrome in China(0).Expert consensus on subclinical Cushing's syndrome in China(2022)[J].International Journal of Endocrinology and Metabolism,2023,43(01):69-76.[doi:10.3760/cma.j.cn121383-20220930-09061]
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2022年亚临床库欣综合征专家指导建议()
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《国际内分泌代谢杂志》[ISSN:1673-4157/CN:12-1383/R]

卷:
43
期数:
2023年01期
页码:
69-76
栏目:
指南与共识
出版日期:
2023-01-20

文章信息/Info

Title:
Expert consensus on subclinical Cushing's syndrome in China(2022)
作者:
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
Author(s):
Expert group for “Expert consensus on subclinical Cushing's syndrome in China(2022)”
关键词:
亚临床库欣综合征;  皮质醇增多;  肾上腺;  垂体
Keywords:
Subclinical Cushing's syndrome;  Increased cortisol;  Adrenal glands;  Pituitary gland
DOI:
10.3760/cma.j.cn121383-20220930-09061
摘要:
亚临床库欣综合征较库欣综合征更常见,指生化检查皮质醇增多而无特异性的典型库欣综合征临床表现,可以导致多种代谢异常,临床上易忽视而相关研究较少,需要重视和规范诊治。亚临床库欣综合征常见于肾上腺意外瘤患者。对于肾上腺或垂体意外瘤以及与年龄、体重不匹配的骨代谢异常或经规范治疗后糖尿病、高血压和脂代谢控制不佳的患者,应进行亚临床库欣综合征筛查。初筛首选1 mg过夜地塞米松抑制试验,确诊试验为小剂量地塞米松抑制试验。诊断后再根据促肾上腺皮质激素水平,结合影像学和其他功能试验进一步明确病变部位及病因。符合手术指征的肾上腺瘤亚临床库欣综合征患者,手术后获得最佳代谢改善。围手术期需进行糖皮质激素补充,术后糖皮质激素替代应个体化。所有患者均应进行定期随访。
Abstract:
Subclinical Cushing's syndrome(SCS)is more common than Cushing's syndrome. It refers to the patients with increased plasma cortisol level but no typical clinical manifestations of Cushing's syndrome. Although SCS can lead to a variety of metabolic abnormalities, it is easily to be ignored in clinical practice and relevant studies are not enough. Therefore, more attention should be paid on the standardized diagnosis and treatment of SCS. SCS is common in patients with accidental adrenal tumors. Screening for SCS should be performed in patients with accidental adrenal or pituitary tumors, age-and weight-mismatched abnormal bone metabolism, or poorly controlled diabetes, hypertension, or lipid metabolism after standardized treatment. Overnight 1 mg dexamethasone inhibition test is preferred for screening test, and low-dose dexamethasone inhibition test is preferred for confirmatory test. Then the location and etiology can be further determined based on plasmaadrenocorticotropic hormone level combined with imaging and other functional tests. SCS patients with adrenal tumors meeting surgical indications can achieve optimal metabolic improvement after surgery. Perioperative glucocorticoid supplementation is recommended, and individualized postoperative hormone replacement is also needed. All patients should be followed up regularly.

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[1]杨菁 郑芬萍.亚临床库欣综合征与代谢异常和结局[J].国际内分泌代谢杂志,2019,39(02):136.[doi:10.3760/cma.j.issn.1673-4157.2019.02.016]
　Yang Jing,Zheng Fenping.Subclinical Cushing's syndrome with metabolic disorders and its outcomes[J].International Journal of Endocrinology and Metabolism,2019,39(01):136.[doi:10.3760/cma.j.issn.1673-4157.2019.02.016]

备注/Memo

备注/Memo:
通信作者:袁戈恒,北京大学第一医院内分泌科,北京 100034; E-mail: 139197109@qq.com
更新日期/Last Update: 2023-01-30