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目的回顾性分析7例肾上腺醛固酮-皮质醇共分泌瘤(A/CPA)患者的临床特点,并进行相关文献复习,以提高对该病的认识和诊疗水平。方法回顾性收集2010—2016年中国人民解放军总医院收治的7例A/CPA患者的临床资料。总结并分析A/CPA患者的一般情况、一般资料、治疗及随访情况。结果 7例A/CPA患者中男1例,女6例;平均就诊年龄(49.1±12.8)岁;体质指数21.5~28.5 kg/m~2;平均肾上腺肿瘤最大直径(3.4±1.6)cm。7例患者均进行血浆醛固酮水平与血浆肾素活性比值(ARR)测定,且均≥25;卡托普利试验和/或生理盐水输注试验结果支持PA诊断。所有患者无典型库欣综合征临床表现,血清皮质醇昼夜节律紊乱,过夜1 mg地塞米松抑制试验或经典小剂量地塞米松抑制试验结果支持亚临床库欣综合征诊断。6例患者术后病理提示为肾上腺皮质腺瘤。术后2例患者出现乏力、食欲不振,其中患者1复查血浆醛固酮水平、血清皮质醇水平明显降低,予泼尼松替代治疗5个月。结论对于肾上腺肿瘤直径>2.0 cm的APA患者,需警惕合并亚临床库欣综合征的可能。术前应完善相关内分泌激素水平测定以明确诊断,术后根据临床症状和激素水平以判定是否需予以糖皮质激素替代治疗。
Objective To retrospectively analyze the clinical features of 7 cases of adrenal aldosterone - cortisol co - secreting tumor (A / CPA) and review relevant literatures to improve the understanding and diagnosis of this disease. Methods The clinical data of 7 A / CPA patients admitted from 2010 to 2016 in Chinese PLA General Hospital were retrospectively collected. To summarize and analyze the general situation, general information, treatment and follow-up of A / CPA patients. Results There were 1 males and 6 females in 7 patients with A / CPA. The mean age at diagnosis was 49.1 ± 12.8 years. The body mass index was 21.5-28.5 kg / m 2. The average diameter of adrenal tumors was 3.4 ± 1.6 cm. All 7 patients were measured plasma aldosterone level and plasma renin activity ratio (ARR), and were ≥ 25; captopril test and / or saline infusion test results support the PA diagnosis. All patients without clinical manifestations of Cushing’s syndrome, serum cortisol circadian rhythm disorders, overnight 1 mg dexamethasone suppression test or classical low-dose dexamethasone suppression test results support the diagnosis of subclinical Cushing’s syndrome. Postoperative pathology of 6 patients showed adrenocortical adenoma. Postoperative 2 patients with fatigue, loss of appetite, in which patients with a review of plasma aldosterone levels, serum cortisol levels were significantly reduced, prednisone replacement therapy for 5 months. Conclusion APA patients with adrenal tumors> 2.0 cm in diameter should be alert to the possibility of subclinical Cushing’s syndrome. Preoperative should be improved to determine the relevant endocrine hormone levels to confirm the diagnosis, postoperative according to clinical symptoms and hormone levels to determine whether the need for glucocorticoid replacement therapy.