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Objective To evaluate the diagnostic significance of ACTH-cortisol rhythm for subclinical Cushing's syndrome (SCS) in patients with adrenal incidentaloma (AI), and explore the best diagnostic cut-off value. Methods The clinical data were collected of patients with AI admitted in Chinese PLA General Hospital from Jan. 2008 to Dec. 2016, and retrospectively analyzed based on the current CS guidelines and confirmed CS by postoperative histopathology. Patients with SCS were set as test group, and with non-functional adrenal adenoma (NFA) as control group. Receiver operating characteristic (ROC) curve was used to evaluate the diagnosis value of ACTH-cortisol rhythm for SCS in patients with AI, and search for the best cut-off value and its corresponding sensitivity and specificity. Results A total of 161 patients with NFA (84 males and 77 females with average age 51.74 years) and 88 patients with SCS (26 males and 62 females with average age 51.02 years) were recruited in present study. ROC analysis showed that the optimal cut-off value for F0:00am/F8:00am was 0.3 (AUC=0.807(95%CI 0.751-0.862, SE=0.029), sensitivity 76.1%, specificity 78.3%, Youden index 0.544, positive predictive value 77.8%, negative predictive value 75.9%); the optimal cut-off value for F0:00am was 113.35nmol/L (AUC=0.841(95%CI 0.792-0.890, SE=0.025), sensitivity 78.4%, specificity 79.5%, positive predictive value 79.3%, negative predictive value 78.6%); the optimal cut-off for ACTH8:00am was 3.0pmol/L (AUC=0.833(95%CI 0.781-0.885), SE=0.027, sensitivity 79.5%, specificity 72.7%, Youden index 0.522, accuracy 76.1%, positive predictive value 74.4%, negative predictive value 78.0%). Conclusion The serum cortisol level at med night 0:00am (F0:00am) is the best parameter in diagnosis of SCS, 113.35nmol/L is recommended as the cut-off point. DOI: 10.11855/j.issn.0577-7402.2018.07.06

Objective To deepen the understanding of 45,X/46,XY mixed gonadal dysgenesis (45,X/46,XY MGD) by summarizing the respective clinical features of patients gathered from China, Brazil, Norway and Denmark suffering from the disease. Methods Comparative analysis was done with the clinical data of 7 patients suffering from 45,X/46,XY MGD diagnosed in the PLA General Hospital of China, and that of other domestic and foreign (Brazil, Norway and Denmark) cases summarized by Peking Union Medical College Hospital. Results Most of the patients of 45,X/46,XY MGD presented the Turner's syndrome-like clinical manifestations such as short stature, multiple naevi on face and lower hair line, etc. Cardiovascular and renal malformation could be found in some patients with 45,X/46,XY MGD. Regarding to the external genitalia, 42.9% (n=27) of the patients were considered to be ambiguous, with a variety of gonadal expression. Laboratory tests demonstrated elevation of follicle-stimulating and/or luteinizing hormone levels with decreased sex hormone levels in most of the patients with 45,X/46,XY MGD. Recombinant human growth hormone (RhGH), testosterone, artificial menstrual cycle and prophylactic gonadectomy were used as primary treatment. There were differences between the domestic and foreign patients in the reason to visit the hospital, and in the age for diagnosis. Chinese patients were always hospitalized for growth retardation, while the foreign patients might go to a doctor for consultation due to various reasons, such as abnormal genitalia, infertility, and fetal chromosomal abnormalities, and many of them might also be diagnosed as 45,X/46,XY MGD in prenatal period or at birth. That was why the average diagnostic age was 4.7 years younger in foreign patients than in Chinese patients. Conclusions No significant difference was found in the clinical characteristics of patients with 45,X/46,XY MGD among different countries and races. But the diagnostic age in Chinese patients is older, and the main reason to consult a doctor is growth retardation. DOI: 10.11855/j.issn.0577-7402.2016.01.14

Objective To analyze the clinical characteristics of the syndrome of inappropriate antidiuretic hormone secretion(SIADH).Methods The clinical and biochemical data of sixty cases of SIADH diagnosed in Chinese PLA General Hospital from Jan.1990 to Oct.2010 were analyzed retrospectively.They were classified into malignant tumor(group A),pulmonary infection(group B),and central nervous system diseases(group C) according to different etiology,and their data were compared.Results The number of patients with diagnosis of SIADH was increasing significantly in recent 5 years,and it was higher than the total number diagnosed in the past 15 years before 1990.The SIADH patients were often admitted to various clinical department to which the patient first visited.The mean age of 60 SIADH patients(41 males and 19 females) was 58.9±15.4 years.Etiology of SIADH was diversified,and it was predominantly malignant tumor,pulmonary infection and central nervous system diseases.The clinical manifestations were mainly that of the digestive system and nervous system.The incidence of mental disorders was higher in patients with serious hyponatremia(57.6%) than in those with mild hyponatremia(11.1%,P < 0.05).Age,serum urea and serum creatinine were higher,while the urine osmolality was lower in patients suffering from lung infection than in those with malignant tumor and central nervous system disease.Other clinical symptoms and laboratory findings were not statistically different among the 3 groups.Conclusion The SIADH is prone to misdiagnosis because of different primary etiology and diverse clinical presentation,so it is important to screen SIADH in elderly patients and those with hyponatremia.