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目的评价肾上腺皮质腺瘤患者高血糖的患病率及术后改变情况。方法选取肾上腺醛固酮瘤(APA组)患者65例、皮质醇瘤(CSA组)患者43例及无功能瘤(NAA组)患者24例行OGTT,并检测激素测值,与原发性高血压(EH组)患者53例及正常对照(NC组)者40名作比较。观察APA、CSA及NAA组行肾上腺肿瘤摘除术后各项指标。结果(1)各组糖尿病患病率分别为44.6%、48.8%、25.0%、24.5%及17.5%。(2)APA、CSA组激素水平与糖代谢指标有相关性。(3)将APA及CSA组分别分为伴或不伴高血糖亚组进行比较,APA组中伴高血糖亚组血醛固酮水平高于不伴高血糖亚组;CSA组中伴高血糖亚组血皮质醇水平高于不伴高血糖亚组。(4)随着术后激素水平的下降,APA、CSA组糖代谢指标得到改善,NAA组激素及糖代指标手术前后比较差异均无统计学意义。3组术后高血糖患病率分为35.4%、32.6%及33.3%。结论功能性肾上腺皮质腺瘤(包括APA和CSA)患者高血糖的患病率升高,其原因与激素的高分泌相关。手术摘除肿瘤,激素高分泌状态解除后,患者的高血糖情况得以改善。
Objective To evaluate the prevalence and postoperative changes of hyperglycemia in patients with adrenocortical adenoma. Methods Totally 65 patients with adrenal aldosterone (APA), 43 patients with cortisol (CSA) and 24 patients with non-functioning neoplasm (NAA) were enrolled in this study. OGTT was measured and the levels of serum total cholesterol EH group) 53 patients and normal control (NC group) 40 were compared. The indexes of APA, CSA and NAA group after adrenalectomy were observed. Results (1) The prevalence of diabetes in each group was 44.6%, 48.8%, 25.0%, 24.5% and 17.5% respectively. (2) There was a correlation between hormone levels of APA and CSA and glucose metabolism index. (3) The APA and CSA groups were divided into groups with or without hyperglycemia, APA group with hyperglycemia subgroup serum aldosterone levels higher than those without hyperglycemia; CSA group with hyperglycemia subgroup Cortisol levels were higher than those without hyperglycemia. (4) With the decrease of postoperative hormone levels, the indexes of glucose metabolism in APA and CSA groups were improved. There was no significant difference between the NAA group before and after the hormone and glycometabolism index. The prevalence of postoperative hyperglycemia in 3 groups was 35.4%, 32.6% and 33.3% respectively. Conclusions The prevalence of hyperglycemia in patients with functional adrenocortical adenomas, including APA and CSA, is elevated due to the association with hormone hypersecretion. Surgery to remove the tumor, the release of hormone hypersecretion, the patient’s hyperglycemia can be improved.