Clinical Analysis Of 52 Patients With ACTH-Independent Cushing's Syndrome

Objective: To investigate the clinical features and effective treatment of patients with ACTH-Independent Cushing's Syndrome.Methods: Clinical data of 52 cases diagnosed as ACTH-Independent Cushing's syndrome in The First Affiliated Hospital of Xinjiang Medical University from September 2008 to September 2018 were collected including general information,clinical manifestations,laboratory test,imageological examination,Surgical treatment and postoperative pathological type.The clinical data of patients with different types of ACTH-Independent Cushing's Syndrome were compared.Results: Among 52 patients,there were 38 case of adrenocortical adenoma,6 case of adrenocortical carcinoma,9 case of adrenocortical nodular hyperplasia,7 cases of male,45 cases of female,17 cases of patients aged 40~49 years.The clinical manifestations were 37 cases with hypertension,32 cases with central obesity and 29 cases with glucose metabolism disorder.Cortisol level at 10: 00(437.81±159.92)nmol/L?cortisol level at 18:00(433.10±194.69)nmol/L ? cortisol level at 02: 00(405.36±151.24)nmol/L,ACTH(1.82±1.81)pg/mL.The suppression ratio of low dose dexamethasone suppression test and high dose dexamethasone suppression test were both less than 50%.CT examination revealed adrenal cortical adenoma in 32 cases,adrenal cortical nodular hyperplasia in 9cases and adrenal malignancy in 5 cases.The levels of 10: 00 plasma cortisol and 24 h urinary free cortisol reduced after operations,the levels of ACTH increased after operations.The pathological diagnosis were cortical adenoma in 30 cases,adrenocortical carcinoma in 4 cases and adrenal cortical nodular hyperplasia in 1 cases.Duration,full moon face,hypertrichosis,cortisol levels at10: 00 and 02: 00,24 h urinary free cortisol level,female testosterone were significantly different among different types of ACTH-Independent Cushing's syndrome(all P<0.05).Conclusion: ACTH-Independent Cushing's syndrome is mainly adrenocortical adenoma and the incidence rate of femalewas high.The onset age of is between 40 and 49 years old.The main clinical manifestations are central obesity,and hypertension.Cortisol circadian rhythm disappear and low dose dexamethasone suppression test and high dose dexamethasone suppression test are not suppressed.Imageological imaging examination is helpful in diagnosing.Surgical treatment is effective.There are differences among different types of ACTH-Independent Cushing's syndrome.