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中华腔镜泌尿外科杂志(电子版) ›› 2026, Vol. 20 ›› Issue (03) : 336 -340. doi: 10.3877/cma.j.issn.1674-3253.2026.03.015

综述

非ACTH依赖型库欣综合征术后三阶段糖皮质激素管理策略
贾莫涵1,2, 双卫兵2,()   
  1. 1030001 太原,山西医科大学第一临床医学院
    2030001 太原,山西医科大学第一医院泌尿外科
  • 收稿日期:2025-10-13 出版日期:2026-06-01
  • 通信作者: 双卫兵

Postoperative three-phase glucocorticoid management strategy for ACTH-independent Cushing's syndrome

Mohan Jia1,2, Weibing Shuang2,()   

  1. 1The First clinical medical college of Shanxi Medical University, Taiyuan 030001, China
    2Department of Urology, First Hospital of Shanxi Medical University, Taiyuan 030001, China
  • Received:2025-10-13 Published:2026-06-01
  • Corresponding author: Weibing Shuang
引用本文:

贾莫涵, 双卫兵. 非ACTH依赖型库欣综合征术后三阶段糖皮质激素管理策略[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2026, 20(03): 336-340.

Mohan Jia, Weibing Shuang. Postoperative three-phase glucocorticoid management strategy for ACTH-independent Cushing's syndrome[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2026, 20(03): 336-340.

非ACTH依赖型库欣综合征(主要包括肾上腺皮质腺瘤和腺癌)术后,因术前长期高皮质醇血症抑制下丘脑-垂体-肾上腺(HPA)轴功能,需进行糖皮质激素替代治疗。本文综述该部分患者术后的三阶段管理策略:急性期(术后0~14 d)以静脉输注氢化可的松为主,依据临床与生化指标逐渐转换为口服;减量期(术后2周~24个月)采用阶梯式剂量递减方案,监测症状及生化指标;远期随访期(>24个月)通过ACTH兴奋试验评估HPA轴恢复情况以决定停药时机。此外,总结儿童、孕妇、老年等特殊人群的用药调整,旨在为临床提供围术期糖皮质激素管理的实践参考。

In patients with ACTH-independent Cushing's syndrome (primarily including adrenal cortical adenomas and adenocarcinomas) following surgery, glucocorticoid replacement therapy is required due to long-term hypercortisolism-induced suppression of the hypothalamic-pituitary-adrenal (HPA) axis function. This article reviews the three-phase management strategy for this population postoperatively: the acute phase (days 0-14 postoperatively) primarily involves intravenous hydrocortisone, with transition to oral administration based on clinical and biochemical indicators; the tapering phase (2 weeks to 24 months postoperatively) employs a stepwise dose reduction regimen while monitoring symptoms and biochemical parameters; and the long-term follow-up phase (>24 months postoperatively) evaluates HPA axis recovery through ACTH stimulation tests to determine the timing of discontinuation. Additionally, medication adjustments for special populations such as children, pregnant women, and elderly patients are summarized. The aim is to provide practical references for perioperative glucocorticoid management in clinical practice.

[1]
Berr CM, Di Dalmazi G, Osswald A, et al. Time to recovery of adrenal function after curative surgery for Cushing's syndrome depends on etiology[J]. J Clin Endocrinol Metab, 2015, 100(4): 1300-1308. DOI: 10.1210/jc.2014-3632.
[2]
中国垂体腺瘤协作组. 中国库欣病诊治专家共识(2015)[J]. 中华医学杂志, 2016, 96(11): 835-840. DOI: 10.3760/cma.j.issn.0376-2491.2016.011.002.
[3]
Reincke M, Fleseriu M. Cushing syndrome: a review[J]. JAMA, 2023, 330(2): 170-181. DOI: 10.1001/jama.2023.11305.
[4]
Di Dalmazi G, Berr CM, Fassnacht M, et al. Adrenal function after adrenalectomy for subclinical hypercortisolism and Cushing's syndrome: a systematic review of the literature[J]. J Clin Endocrinol Metab, 2014, 99(8): 2637-2645. DOI: 10.1210/jc.2014-1401.
[5]
Kohler S, Karavitaki N, Wass JAH. Post-operative replacement and assessment of HPA axis recovery in Cushing's syndrome[M]//Bronstein MD. Cushing's Syndrome: Pathophysiology, Diagnosis and Treatment. Totowa, NJ: Humana Press, 2011: 249-258. DOI: 10.1007/978-1-60327-449-4_20.
[6]
Balasko A, Zibar Tomsic K, Kastelan D, et al. Hypothalamic-pituitary-adrenal axis recovery after treatment of Cushing's syndrome[J]. J Neuroendocrinol, 2022, 34(8): e13172. DOI: 10.1111/jne.13172.
[7]
Dineen R, Martin-Grace J, Thompson CJ, et al. The management of glucocorticoid deficiency: Current and future perspectives[J]. Clin Chim Acta, 2020, 505: 148-159. DOI: 10.1016/j.cca.2020.03.006.
[8]
Cui Q, Liu D, Xiang B, et al. Morning serum cortisol as a predictor for the HPA axis recovery in Cushing's disease[J]. Int J Endocrinol, 2021, 2021: 4586229. DOI: 10.1155/2021/4586229.
[9]
Scherholz ML, Schlesinger N, Androulakis IP. Chronopharmacology of glucocorticoids[J]. Adv Drug Deliv Rev, 2019, 151-152: 245-261. DOI: 10.1016/j.addr.2019.02.004.
[10]
Tang K, Wang L, Yang Z, et al. Comparison of hydrocortisone and prednisone in the glucocorticoid replacement therapy post-adrenalectomy of Cushing’s Syndrome[J]. Oncotarget, 2017, 8(62): 106113-106120. DOI: 10.18632/oncotarget.20597.
[11]
Gadelha M, Gatto F, Wildemberg LE, et al. Cushing's Syndrome[J]. Lancet, 2023, 402(10418): 2237-2252. DOI: 10.1016/S0140-6736(23)01961-X.
[12]
Fujii K, Miyashita K, Kurihara I, et al. Adrenal insufficiency under standard dosage of glucocorticoid replacement after unilateral adrenalectomy for Cushing's syndrome[J]. Case Rep Endocrinol, 2016, 2016(1): 2347528. DOI: 10.1155/2016/2347528.
[13]
McGlotten R, Nieman LK. MON-167 use of a morning Cortisol level to predict recovery of the hypothalamic-pituitary-adrenal (HPA) axis in secondary adrenal insufficiency following remission of Cushing's syndrome[J]. J Endocr Soc, 2020, 4(Supplement_1): MON-167. DOI: 10.1210/jendso/bvaa046.616.
[14]
Zhang CD, Ioachimescu AG. Challenges in the postsurgical recovery of cushing syndrome: glucocorticoid withdrawal syndrome[J]. Front Endocrinol, 2024, 15: 1353543. DOI: 10.3389/fendo.2024.1353543.
[15]
Polovina TS, Kraljevic I, Solak M, et al. Early basal Cortisol level as a predictor of hypothalamic-pituitary-adrenal (HPA) axis function after pituitary tumor surgery[J]. Exp clin Endocrinol Diabetes, 2020, 128(11): 709-714. DOI: 10.1055/a-0885-1568.
[16]
Pilon A, Laudat A. Exploration biochimique de la corticosurrénale[J]. Rev Francophone Des Laboratoires, 2022, 2022(544): 26-35. DOI: 10.1016/S1773-035X(22)00246-5.
[17]
Martin-Grace J, Tomkins M, O'Reilly MW, et al. Iatrogenic adrenal insufficiency in adults[J]. Nat Rev Endocrinol, 2024, 20(4): 209-227. DOI: 10.1038/s41574-023-00929-x.
[18]
Filipsson H, Monson JP, Koltowska-Häggström M, et al. The impact of glucocorticoid replacement regimens on metabolic outcome and comorbidity in hypopituitary patients[J]. J Clin Endocrinol Metab, 2006, 91(10): 3954-3961. DOI: 10.1210/jc.2006-0524.
[19]
Asuzu DT, Bhatt S, Nwokoye D, et al. Cortisol and ACTH measurements at extubation from pituitary surgery predicts hypothalamic-pituitary-adrenal axis function[J]. J Endocr Soc, 2023, 7(4): bvad025. DOI: 10.1210/jendso/bvad025.
[20]
Suliman AM, Freaney R, Smith TP, et al. The impact of different glucocorticoid replacement schedules on bone turnover and insulin sensitivity in patients with adrenal insufficiency[J]. Clin Endocrinol, 2003, 59(3): 380-387. DOI: 10.1046/j.1365-2265.2003.01860.x.
[21]
Falcetta P, Orsolini F, Benelli E, et al. Clinical features, risk of mass enlargement, and development of endocrine hyperfunction in patients with adrenal incidentalomas: a long-term follow-up study[J]. Endocrine, 2021, 71(1): 178-188. DOI: 10.1007/s12020-020-02476-1.
[22]
Neumann U, Braune K, Whitaker MJ, et al. A prospective study of children aged 0-8 years with CAH and adrenal insufficiency treated with hydrocortisone granules[J]. J Clin Endocrinol Metab, 2021, 106(3): e1433-e1440. DOI: 10.1210/clinem/dgaa626.
[23]
Mittal M, Jain V. Management of obesity and its complications in children and adolescents[J]. Indian J Pediatr, 2021, 88(12): 1222-1234. DOI: 10.1007/s12098-021-03913-3.
[24]
Tatsi C, Stratakis CA. Pediatric Cushing syndrome; an overview. Pediatr Endocrinol Rev. 2019, 17(2): 100-109. DOI: 10.17458/per.vol17.2019.
[25]
Sugawara H, Wada N, Baba S, et al. A case of Cushing's syndrome in a pregnant woman associated with hypertension, hypokalemia, and gestational diabetes mellitus[J]. Diabetol Int, 2024, 15(4): 845-849. DOI: 10.1007/s13340-024-00745-2.
[26]
Jin M, Xu H. The treatment of gestational diabetes mellitus[J]. J Biosci Med, 2023, 11(4): 407-416. DOI: 10.4236/jbm.2023.114029.
[27]
Deitch JM, Lee IL, Yates CJ, et al. Simplified gestational diabetes screening with a triaging fasting plasma glucose reduces the burden of oral glucose tolerance tests during pregnancy-A large tertiary comparative cohort study[J]. Diabetes Res Clin Pract, 2024, 209: 111120. DOI: 10.1016/j.diabres.2024.111120.
[28]
Dineen R, Behan LA, Kelleher G, et al. The contribution of serum cortisone and glucocorticoid metabolites to detrimental bone health in patients receiving hydrocortisone therapy[J]. BMC Endocr Disord, 2020, 20(1): 154. DOI: 10.1186/s12902-020-00633-1.
[29]
刘岑, 赵紫楠, 陈頔, 等. 库欣综合征的诊疗进展[J]. 罕见病研究, 2024, 3(2): 187-194. DOI: 10.12376/j.issn.2097-0501.2024.02.006.
[30]
Limbachia V, Nunney I, Page DJ, et al. The effect of different types of oral or intravenous corticosteroids on capillary blood glucose levels in hospitalized inpatients with and without diabetes[J]. Clin Ther, 2024, 46(2): e59-e63. DOI: 10.1016/j.clinthera.2023.11.013.
[31]
Beuschlein F, Else T, Bancos I, et al. European Society of Endocrinology and Endocrine Society Joint Clinical Guideline: diagnosis and therapy of glucocorticoid-induced adrenal insufficiency. J Clin Endocrinol Metab. 2024, 109(7): 1657-1683. DOI: 10.1210/clinem/dgae250.
[32]
Aulinas A, Valassi E, Webb SM. Prognosis of patients treated for Cushing syndrome[J]. Endocrinol Nutr, 2014, 61(1): 52-61. DOI: 10.1016/j.endonu.2013.03.008.
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