Glucocorticoid withdrawal syndrome following surgical remission of endogenous hypercortisolism: a longitudinal observational study.
Glucocorticoid withdrawal syndrome following surgical remission of endogenous hypercortisolism: a longitudinal observational study.
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内源性皮质醇增多症手术缓解后糖皮质激素戒断综合征：一项纵向观察研究。
DOI：
10.1093/ejendo/lvad073
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发表时间：
2023
影响因子：
5.8
通讯作者：
Bancos,Irina
中科院分区：
文献类型：
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作者：
Zhang,CatherineD;Li,Dingfeng;Singh,Sumitabh;Suresh,Malavika;Thangamuthu,Karthik;Nathani,Rohit;Achenbach,SaraJ;Atkinson,ElizabethJ;VanGompel,JamieJ;Young,WilliamF;Bancos,Irina
糖皮质激素戒断综合征（GWS）是一种很少研究的现象，它使皮质醇增多症手术缓解后的恢复复杂化。我们的目的是描述糖皮质激素戒断症状的存在和轨迹在术后期间，并确定术前预测GWS severity.DesignLongitudinal observational study.MethodsGlucocorticoid戒断症状进行了前瞻性评估每周为第一个12周手术缓解皮质醇增多症。生活质量（CushingQoL和短形式-36）和肌肉功能（手握力和坐站试验）进行了评估，在基线和12周后surgical.ResultsPrevalent症状肌痛和关节痛（50%），疲劳（45%），虚弱（34%），睡眠障碍（29%），情绪变化（19%）。术后5-12周，大多数症状持续存在，而肌痛、关节痛和虚弱加重。术后12周，标准手握力较基线时弱（平均Z-评分δ-0.37，P = 0.009），而标准坐立测试表现改善（平均Z-评分δ 0.50，P = 0.013）。与基线相比，12周时，36项简明身体健康量表总分恶化（平均δ-2.6，P = .015），但CushingQoL评分改善（平均δ 7.8，P < .001）。库欣综合征（CS）的临床严重程度是预测术后GWS mathology.ConclusionGlucocorticoid戒断症状是普遍存在的，并持续以下手术缓解皮质醇增多症与基线CS临床严重程度预测术后GWS症状负担。在术后早期观察到的肌肉功能和生活质量的差异变化可能反映了GWS和皮质醇增多症恢复的竞争影响。
ObjectiveGlucocorticoid withdrawal syndrome (GWS) is a scarcely studied phenomenon that complicates the recovery following surgical remission of hypercortisolism. We aimed to characterize the presence and trajectory of glucocorticoid withdrawal symptoms in the postoperative period and to determine presurgical predictors of GWS severity.DesignLongitudinal observational study.MethodsGlucocorticoid withdrawal symptoms were prospectively evaluated weekly for the first 12 weeks following surgical remission of hypercortisolism. Quality of life (CushingQoL and Short-Form-36) and muscle function (hand grip strength and sit-to-stand test) were assessed at the baseline and at 12 weeks after surgery.ResultsPrevalent symptoms were myalgias and arthralgias (50%), fatigue (45%), weakness (34%), sleep disturbance (29%), and mood changes (19%). Most symptoms persisted, while myalgias, arthralgias, and weakness worsened during weeks 5-12 postoperatively. At 12 weeks after surgery, normative hand grip strength was weaker than at baseline (meanZ-score delta −0.37,P= .009), while normative sit-to-stand test performance improved (meanZ-score delta 0.50,P= .013). Short-Form-36 Physical Component Summary score worsened (mean delta −2.6,P= .015), but CushingQoL score improved (mean delta 7.8,P< .001) at 12 weeks compared to baseline. Cushing syndrome (CS) clinical severity was predictive of postoperative GWS symptomology.ConclusionGlucocorticoid withdrawal symptoms are prevalent and persistent following surgical remission of hypercortisolism with baseline CS clinical severity predictive of postoperative GWS symptom burden. Differential changes observed in muscle function and quality of life in the early postoperative period may reflect the competing influences of GWS and recovery from hypercortisolism.