Supplemental Digital Content is available in the text. The clinical characteristics and outcomes in patients with clinical aldosterone-producing adenomas harboring KCNJ5 mutations with or without subclinical hypercortisolism remain unclear. This prospective study is aimed at determining factors associated with subclinical hypercortisolism in patients with clinical aldosterone-producing adenomas. Totally, 82 patients were recruited from November 2016 to March 2018 and underwent unilateral laparoscopic adrenalectomy with at least a 12-month follow-up postoperatively. Standard subclinical hypercortisolism (defined as cortisol >1.8 μg/dL after 1 mg dexamethasone suppression test [DST]) was detected in 22 (26.8%) of the 82 patients. Intriguingly, a generalized additive model identified the clinical aldosterone-producing adenoma patients with 1 mg DST>1.5 μg/dL had significantly larger tumors (P=0.02) than those with 1 mg DST<1.5 μg/dL. Multivariable logistic regression showed that the presence of KCNJ5 mutations (odds ratio, 0.22, P=0.010) and body mass index (odds ratio, 0.87, P=0.046) were negatively associated with 1 mg DST>1.5 μg/dL, whereas tumor size was positively associated with it (odds ratio, 2.85, P=0.014). Immunohistochemistry revealed a higher degree of immunoreactivity for CYP11B1 in adenomas with wild-type KCNJ5 (P=0.018), whereas CYP11B2 was more commonly detected in adenomas with KCNJ5 mutation (P=0.007). Patients with wild-type KCNJ5 and 1 mg DST>1.5 μg/dL exhibited the lowest complete clinical success rate (36.8%) after adrenalectomy. In conclusion, subclinical hypercortisolism is common in clinical aldosterone-producing adenoma patients without KCNJ5 mutation or with a relatively larger adrenal tumor. The presence of serum cortisol levels >1.5 μg/dL after 1 mg DST may be linked to a lower clinical complete success rate.

中文翻译：

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临床产醛固酮腺瘤中亚临床皮质醇增多症的存在预示着较低的临床成功率

补充数字内容在文本中可用。伴有或不伴有亚临床皮质醇增多症的 KCNJ5 突变的临床产醛固酮腺瘤患者的临床特征和结果仍不清楚。这项前瞻性研究旨在确定与临床产醛固酮腺瘤患者亚临床皮质醇增多症相关的因素。2016 年 11 月至 2018 年 3 月共招募 82 名患者，接受单侧腹腔镜肾上腺切除术，术后随访至少 12 个月。82 名患者中有 22 名 (26.8%) 检测到标准的亚临床皮质醇增多症（定义为 1 mg 地塞米松抑制试验 [DST] 后皮质醇 >1.8 μg/dL）。耐人寻味的是，一个广义的加性模型确定了 1 mg DST>1.5 μg/dL 的临床产醛固酮腺瘤患者的肿瘤明显大于 1 mg DST <1.5 μg/dL 的患者（P=0.02）。多变量逻辑回归显示 KCNJ5 突变的存在（优势比，0.22，P=0.010）和体重指数（优势比，0.87，P=0.046）与 1 mg DST>1.5 μg/dL 呈负相关，而肿瘤大小正相关（优势比，2.85，P=0.014）。免疫组织化学显示具有野生型 KCNJ5 的腺瘤中 CYP11B1 的免疫反应程度更高（P=0.018），而 CYP11B2 在具有 KCNJ5 突变的腺瘤中更常见（P=0.007）。具有野生型 KCNJ5 和 1 mg DST>1.5 μg/dL 的患者在肾上腺切除术后表现出最低的完全临床成功率 (36.8%)。综上所述，亚临床皮质醇增多症在没有 KCNJ5 突变或肾上腺肿瘤相对较大的临床产醛固酮腺瘤患者中很常见。1 mg DST 后血清皮质醇水平 >1.5 μg/dL 的存在可能与较低的临床完全成功率有关。