Subclinical Cushing's syndrome (SCS) is a common subtype of adrenal incidentaloma. There are few reports on the correlation between hyperglycemia and hypercortisone secretion and its postoperative change in SCS patients.

To assess the pre- and post-surgical prevalence of hyperglycemia in patients with SCS secondary to adrenal incidentaloma.

The data of 202 patients who consulted in respiratory department of endocrinology, renhe hospital affiliated to shanghai university (shanghai baoshan district renhe hospital). Participants included 36 SCS patients, 41 patients with Cushing's syndrome due to adrenal tumor (CSA), 47 with nonfunctional adrenal tumor (NAT), and 53 controls. OGTT was performed in all of them, and based on the results, HOMA-IR, the area under the curve of blood glucose (AUCGlu) and insulin (AUCIns) were calculated, and plasma cortisol and urinary free cortisol and plasma ACTH were measured, then the values of the parameters were compared between controls and patients. Surgical treatment was given to SCS and CSA patients. The association of hormone and glucose metabolism parameters was assessed using Pearson correlation analysis.

The prevalence of hyperglycemia in SCS, CSA and NAT patients before surgery and in controls was 41.7%, 51.2%, 25.5%, and 24.5%, respectively. The HbA_1c, 2-hour post-load insulin (2 hPIN), AUCGlu and AUCIns in SCS patients were higher than those of controls (P<0.05). CSA patients had higher fasting insulin, AUCIns and HOMA-IR than SCS patients, NAT patients and controls (P<0.05). CSA patients had higher HbA_1c, fasting plasma glucose (FPG), 2-hour post-load plasma glucose (2 hPPG), 2 hPIN and AUCGlu than NAT patients and controls (P<0.05). After controlling for sex and age, in SCS patients, HbA_1c was positively associated with cortisol measured at 8: 00 and 16: 00 on the day after admission, and 24-hour urinary free cortisol (r=0.68, 0.657, 0.522, P<0.05), and so was 2 hPPG (r=0.569, 0.544, 0.369, P<0.05) ; FPG was positively associated with cortisol measured at 8: 00 on the day after admission (r=0.434, P<0.05) ; AUCGlu was positively associated with cortisol measured at 8: 00 and 16: 00 on the day after admission (r=0.397, 0.409, P<0.05). In CSA group, HbA_1c was positively associated with cortisol measured at 8: 00 on the day after admission (r=0.748, P<0.05), and so was FPG, 2 hPPG, AUCGlu, and 2 hPIN (r=0.631, 0.669, 0.602, 0.319, P<0.05). HbA_1c was also positively associated with cortisol measured at 16: 00 on the day after admission (r=0.674, P<0.05), and so was FPG, 2 hPPG, AUCGlu, (r=0.655, 0.640, 0.624, P<0.05). Plasma cortisol and 24-hour urinary free cortisol decreased in SCS and CSA patients after surgery (P<0.05). 2 hPIN and AUCIns decreased in SCS patients after surgery (P<0.05). FIN, 2 hPIN, AUCGlu, AUCIns and HOMA-IR decreased in CSA patients after surgery (P<0.05). The postsurgical prevalence of hyperglycemia SCS and CSA patients was 33.3% and 39.0%, respectively.

The high prevalence of hyperglycemia may be related to high secretion of glucocorticoid in SCS patients, and the hyperglycemic condition was improved after surgical treatment.

亚临床库欣综合征（SCS）是肾上腺意外瘤的常见亚型，但目前对于SCS患者高血糖与高皮质醇分泌的相关性分析及术后变化情况鲜有报道。

评价肾上腺意外瘤SCS患者高血糖的患病情况及其术后变化。

收集2010—2021年上海大学附属仁和医院（上海市宝山区仁和医院）诊治的124例患者资料并进行统计分析。对其中36例SCS患者（SCS组）、41例肾上腺腺瘤型库欣综合征患者（CSA组）及47例肾上腺无功能瘤患者（NAA组）行口服糖耐量检查（OGTT），并计算胰岛素抵抗指数（HOMA-IR）、葡萄糖曲线下面积（AUC Glu）、胰岛素曲线下面积（AUC Ins），检测患者血皮质醇、尿皮质醇、血促肾上腺皮质激素（ACTH）等激素测值，将所得结果与53例受试者（对照组）进行比较。SCS组、CSA组所有患者均经手术治疗，采用Pearson相关性分析比较SCS组、CSA组激素与糖代谢测值的相关性。

SCS组、CSA组、NAA组、对照组高血糖患病率分别为41.7%、51.2%、25.5%及24.5%。SCS组患者糖化血红蛋白（HbA_1c）、糖负荷后2 h胰岛素（2 hPIN）、AUCGlu及AUCIns均高于对照组（P<0.05），CSA组患者空腹胰岛素（FIN）、AUCIns及HOMA-IR均高于SCS组、NAA组及对照组（P<0.05），CSA组患者HbA_1c、FPG、糖负荷后2 h血糖（2 hPPG）、2 hPIN及AUCGlu均高于NAA组、对照组（P<0.05）。剔除性别、年龄影响，SCS组患者HbA_1c、2 hPPG与8：00、16：00血皮质醇、尿游离皮质醇呈正相关（r=0.68，0.657，0.522，P<0.05；r=0.569，0.544，0.369，P<0.05），FPG与8：00血皮质醇呈正相关（r=0.434、P<0.05），AUCGlu与8：00、16：00血皮质醇呈正相关（r=0.397，0.409，P<0.05）；CSA组患者HbA_1c、FPG、2 hPPG、AUCGlu与8：00、16：00血皮质醇呈正相关（r=0.748，0.631，0.669，0.602，P<0.05；r=0.674，0.655，0.640，0.624，P<005），2 hPIN与8：00血皮质醇呈正相关（r=0.319，P<0.05）。SCS组、CSA组患者术后与术前相比，血皮质醇、尿皮质醇水平下降（P<0.05）。SCS组患者术后与术前相比，2 hPIN、AUCIns下降（P<0.05）；CSA组患者术后与术前相比，FIN、2 hPIN、AUCGlu、AUCIns及HOMA-IR均下降（P<0.05）。SCS组、CSA组患者术后高血糖的患病率分为33.3%及39.0%。

SCS患者高血糖的患病率升高，其原因与皮质醇的高分泌有关。手术治疗后高血糖情况得以改善。