Objective: To analyze the clinical characteristics and prognosis of patients with primary aldosteronism (PA) associated with subclinical Cushing syndrome (SCS). Methods: This retrospective cohort study was conducted at the First Affiliated Hospital of Chongqing Medical University in China. Patients with PA were included between January 2014 and December 2022. According to the results of 1-mg overnight dexamethasone suppression test, the patients were divided into the PA group and PA associated with SCS (PA/SCS) group. The demographic information, hormone levels, and follow-up results were analyzed. Independent sample t-test, chi-square test and Mann-Whitney U test were used for data comparison. Results: A total of 489 PA patients were enrolled in this study, of which 109 had PA/SCS (22.3%). Patients with SCS were on average older (54.4±10.7 vs. 47.4±11.0, P<0.001); had a larger proportion of women (69.7%, 76/109 vs. 57.4%, 218/380; P=0.020); and a longer duration of hypertension [96 (36, 180) vs. 60 (12, 120) months, P=0.001] than patients without SCS. There were 215 and 51 patients in the PA group and PA/SCS group, who completed adrenalectomy and follow-up, respectively. The remission rate of autonomous cortisol secretion in the PA/SCS group was 85.3% (29/34). There was no significant difference in the remission rate of autonomous aldosterone secretion among patients between the PA/SCS and PA group (94.1%, 48/51 vs. 94.4%, 203/215; P=1.000), while the clinical remission rate in the PA/SCS group was lower than that in the PA group (39.2%, 20/51 vs. 61.9%, 133/215; P=0.003). Conclusions: SCS is common in PA patients (22.3%), and the clinical remission rate is low. Screening using the 1-mg overnight dexamethasone suppression test is recommended for all patients with PA.
目的： 分析原发性醛固酮增多症（PA）合并亚临床库欣综合征（SCS）患者的临床特征及预后。 方法： 回顾性队列研究。收集2014年1月至2022年12月重庆医科大学附属第一医院收治的PA患者的临床资料。根据1 mg过夜地塞米松抑制试验结果将患者分成单纯PA组和PA合并SCS（PA/SCS）组，分析两组间的人口学信息、激素水平及随访结果等。采用独立样本t检验、χ2检验、Mann-Whitney U检验等进行组间比较。 结果： 共纳入489例PA患者，其中109例（22.3%）为PA/SCS患者。与单纯PA组相比，PA/SCS组年龄更大［（54.4±10.7）岁比（47.4±11.0）岁，P<0.001］，女性比例更多［69.7%（76/109）比57.4%（218/380），P=0.020］，高血压病程更长［96（36，180）个月比60（12，120）个月，P=0.001］。单纯PA组和PA/SCS组分别有215例和51例完成手术及随访。PA/SCS组皮质醇自主分泌完全缓解率为85.3%（29/34），醛固酮自主分泌完全缓解率与单纯PA组相当［94.1%（48/51）比94.4%（203/215），P=1.000］；而PA/SCS组的临床完全缓解率低于单纯PA组［39.2%（20/51）比61.9%（133/215），P=0.003］。 结论： 在PA患者中SCS较为多见（22.3%），其术后临床完全缓解率较低。推荐对所有PA患者采用1 mg过夜地塞米松抑制试验进行筛查。.