单侧肾上腺切除治疗原发性醛固酮增多症对侧肾上腺储备功能的评价分析

摘要

ABSTRACT:Objective After unilateral adrenalectomy (uADX ) in patients with primary aldosteronism , the remaining contralateral adrenal gland is generally considered sufficient to support life .However ,few studies have compared adrenal re‐serve function before and after uADX .Therefore ,we closely evaluated adrenal cortisol secretory function before and after uADX in patients with primary aldosteronism .Methods From Jan .2006 to Feb .2013 ,a total of 42 patients who were diag‐nosed with primary aldosteronism and underwent uADX were initially included in this study .Patients with subclinical Cushing's syndrome (SCS) or Cushing's syndrome were excluded on suspicion of autonomous cortisol secretion .All 42 patients were final‐ly evaluated .Morning basal serum cortisol and plasma adrenocorticotropin hormone (ACTH) levels were measured ,and ACTH stimulation tests under 1‐mg dexamethasone suppression (dex‐ACTH test) were performed before and after uADX .Results No patient developed clinical adrenal insufficiency . Basal cortisol levels were not significantly different before and after uADX .However ,basal ACTH levels were significantly elevated after uADX .In addition ,peak cortisol levels on the dex‐ACTH test decreased in all patients after uADX .The peak cortisol level after uADX was 82 .7 (76 .0-91 .4)% of the level be‐fore uADX .Conclusions The adrenal cortisol reserve function is mildly reduced after uADX in patients without SCS or Cushing's syndrome ,although their basal cortisol level is sustained by elevated ACTH .Nevertheless ,more than 80% of the re‐serve capacity is preserved after uADX ,which is compatible with the fact that patients generally exhibit no problems in daily life after uADX .%目的：对比分析原发性醛固酮增多症（PHA）患者单侧肾上腺切除前后肾上腺皮质分泌功能变化，评估分析单侧肾上腺切除后对侧肾上腺皮质储备功能。方法选取2006年1月至2013年2月接受单侧肾上腺切除手术的42例患者的临床资料。对患者手术前后早晨空腹血皮质醇、促肾上腺皮质素（ACT H ）水平、以及促肾上腺皮质激素兴奋1 mg地塞米松抑制试验结果进行了有效的统计学分析。结果42例患者均无出现肾上腺皮质功能不全。手术前后基础皮质醇水平无明显差异。然而，单侧肾上腺切除术后基础ACT H水平明显提高。促肾上腺皮质激素兴奋1 mg地塞米松抑制试验的皮质醇峰值水平明显下降。术后皮质醇峰值水平约为术前82．7％（76．0％～91．4％）。结论不伴有皮质醇增多症或亚临床型皮质醇增多症的P H A患者行单侧肾上腺切除，术后血皮质醇水平可维持在正常范围之内，但肾上腺皮质储备功能出现不同程度的下降，其储备功能不低于术前80％，足以使患者术后不会出现肾上腺皮质功能不全。