库欣综合征致继发性高血压误诊为原发性高血压的临床特点及原因探讨OA

Objective To analyze the clinical characteristics and causes of misdiagnosis of secondary hypertension caused by Cushing's syndrome as primary hypertension.Methods A retrospective analysis was conducted on the case data of 7 patients who were initially diagnosed with primary hypertension but were ultimately confirmed to have Cushing's syndrome and were admitted to the First Hospital of Handan City from January 2018 to December 2023.Results All 7 patients presented with moderate to severe hypertension as the main manifestation.All were initially diagnosed with primary hypertension and did not respond well to conventional antihypertensive treatment.Among them,3 patients had no obvious typical signs of Cushing's syndrome;2 patients presented with hypertension accompanied by hypokalemia as the initial symptom and were suspected of having primary aldosteronism but no adenoma was found in the adrenal CT;2 patients manifested as resistant hypertension combined with new-onset diabetes.All patients were evaluated through endocrinological function tests,including 24-hour urine free cortisol,midnight salivary cortisol,and low-dose Dexamethasone suppression test,and were diagnosed with Cushing's syndrome.Imaging examinations indicated pituitary adenoma in 4 patients,adrenal adenoma in 2 patients,and ectopic adrenocorticotropic hormone(ACTH)syndrome in 1 patient.The misdiagnosis period ranged from 5 months to 3 years.After diagnosis,6 patients received surgical treatment(pituitary adenomectomy or adrenal adenomectomy or thymic carcinoid resection),and 1 patient received drug treatment.Follow-up was conducted for 6 to 24 months.The blood pressure of 6 patients significantly improved,among which 4 patients had their blood pressure completely returned to normal,and 2 patients reduced the dosage of antihypertensive drugs by more than 50%;1 patient died due to advanced multi-organ failure caused by ectopic ACTH syndrome.Conclusion The clinical manifestations of secondary hypertension caused by Cushing's syndrome are insidious and diverse,making it more likely to be misdiagnosed as primary hypertension.For resistant hypertension,especially those with atypical symptoms such as central obesity,hypokalemia,and hyperglycemia,one should be alert to the possibility of endocrine hypertension and conduct early screening for cortisol function to improve the accuracy of diagnosis.