Association of hypertension and hypokalemia with Cushing's syndrome caused by ectopic ACTH secretion

DOI：

10.1111/j.1749-6632.2002.tb04419.x

发表时间：

2002-01-01

期刊：

ENDOCRINE HYPERTENSION

影响因子：

通讯作者：

中科院分区：

其他

文献类型：

作者：

Torpy, DJ;Mullen, N;Nieman, LK

大约 80% 的库欣综合征与高血压有关。高血压导致过去或当前库欣综合征的死亡风险显着增加，很大程度上是因为心血管风险增加。对异位 ACTH 分泌患者中 ACTH 和皮质醇值长期升高的病理生理学效应的观察补充了正常志愿者中 ACTH 和糖皮质激素输注影响的急性研究的现有数据。在一项回顾性病例回顾中，我们确定了 58 名由异位 ACTH 分泌引起的库欣综合征患者，这些患者于 1983 年至 1997 年间在美国国立卫生研究院接受治疗。异位 ACTH 病因的诊断通过岩下窦取样和/或肿瘤病理检查得到证实。最常见的原因是支气管类癌 (40%) 和胸腺类癌 (10%)，但 58 名患者中有 18 名 (31%) 异位 ACTH 来源不明。 58 名异位库欣综合征患者中有 45 名 (78%) 发现高血压（成人收缩压 >140 mmHg 和/或舒张压 >90 mmHg），其患病率与其他内源性库欣综合征病因相似。 58 名患者中有 26 名 (45%) 患有严重高血压，治疗医生认为需要 3 种或更多药物。低钾血症比其他原因引起的库欣综合征患者更为普遍，影响了 58 名患者中的 33 名 (57%)。血浆ACTH范围（17-1557 pg/mL，正常

Cushing's syndrome is associated with hypertension in approximately 80% of cases. Hypertension contributes to the marked increased mortality risk of past or current Cushing's syndrome, largely because of increased cardiovascular risk. Observation of the pathophysiological effect of chronically elevated ACTH and cortisol values in patients with ectopic ACTH secretion complements the available data from acute studies of the effects of ACTH and glucocorticoid infusions in normal volunteers. In a retrospective case review, we identified 58 patients with Cushing's syndrome caused by ectopic ACTH secretion, who were treated at the National Institutes of Health between 1983-1997. The diagnosis of an ectopic ACTH cause was confirmed by inferior petrosal sinus sampling and/or pathologic examination of tumor. The commonest causes were bronchial carcinoid (40%) and thymic carcinoid (10%), but 18 of 58 (31%) patients had an unknown source of ectopic ACTH. Hypertension (systolic blood pressure >140 mmHg and/or diastolic blood pressure >90 mmHg in adults) was noted in 45 of 58 (78%) ectopic Cushing's patients, a prevalence similar to that noted in other endogenous Cushing's syndrome etiologies. Hypertension was severe, deemed to require 3 or more drugs by the treating physicians, in 26 of 58 (45%) patients. Hypokalemia was much more prevalent than in patients with other causes of Cushing's syndrome, affecting 33 of 58 (57%) patients. The range of plasma ACTH (17-1557 pg/mL, normal

Association of hypertension and hypokalemia with Cushing's syndrome caused by ectopic ACTH secretion - A series of 58 cases

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