国际内分泌代谢杂志2023年1月第43卷第1期nt J Endocrinol Metab,January2023,Vl.43,No.1·69··指南与共识·2022年亚临床库欣综合征专家指导建议白求恩精神研究会内分泌和糖尿病学分会《2022年亚临床库欣综合征专家指导建议》编写组通信作者：袁戈恒，北京大学第一医院内分泌料，北京100034：E-mail:139197109@qq.com【摘要】亚临床库欣综合征较库欣综合征更常见，指生化检查皮质醇增多而无特异性的典型库欣综合征临床表现，可以导致多种代谢异常，临床上易忽视而相关研究较少，需要重视和规范诊治。亚临床库欣综合征常见于肾上腺意外瘤患者。对于肾上腺或垂体意外瘤以及与年龄、体重不匹配的骨代谢异常或经规范治疗后糖尿病、高血压和脂代谢控制不佳的患者，应进行亚临床库欣综合征筛查。初筛首选1吗过夜地塞米松抑制试验，确诊试验为小剂量地塞米松抑制试验。诊断后再根据促肾上腺皮质激素水平，结合影像学和其他功能试验进一步明确病变部位及病因。符合手术指征的肾上腺瘤亚临床库欣综合征患者，手术后获得最佳代谢改善。围手术期需进行糖皮质激素补充，术后糖皮质激素替代应个体化。所有患者均应进行定期随访。【关键词】亚临床库欣综合征：皮质醇增多：肾上腺；垂体D01:10.3760/cma.j.cm121383-20220930-09061Expert consensus on subclinical Cushing's syndrome in China (2022)Expert group for "Expert con-sensus on subelinical Cushing's syndrome in China(2022)"Corresponding author:Yuan Geheng,Department of Endocrinology,PKU First Hospital,Peking 100034,China,Email:139197109@qq.com[Abstract]Subclinical Cushing's syndrome (SCS)is more common than Cushing's syndrome.It re-fers to the patients with increased plasma cortisol level but no typical clinical manifestations of Cushing'ssyndrome.Although SCS can lead to a variety of metabolic abnormalities,it is easily to be ignored in clinicalpractice and relevant studies are not enough.Therefore,more attention should be paid on the standardizeddiagnosis and treatment of SCS.SCS is common in patients with accidental adrenal tumors.Screening forSCS should be performed in patients with accidental adrenal or pituitary tumors,age-and weight-mismatchedabnormal bone metabolism,or poorly controlled diabetes,hypertension,or lipid metabolism after standard-ized treatment.Overnight I mg dexamethasone inhibition test is preferred for screening test,and low-dosedexamethasone inhibition test is preferred for confirmatory test.Then the location and etiology can be furtherdetermined based on plasma adrenocorticotropic hormone level combined with imaging and other functionaltests.SCS patients with adrenal tumors meeting surgical indications can achieve optimal metabolic improve-ment after surgery.Perioperative glucocorticoid supplementation is recommended,and individualized postop-erative hormone replacement is also needed.All patients should be followed up regularly.Keywords]Subclinical Cushing's syndrome;Increased cortisol;Adrenal glands;Pituitary glandD01:10.3760/cma.i.cm121383-20220930-090611前言紫纹等，其中最重要的是缺乏分解代谢增强特征，如亚临床库欣综合征(subclinical Cushing's syn-中央肌无力、脂肪组织再分配、皮肤脆弱和少见的感drome,SCS)是指生化检查证明存在下丘脑-垂体.肾染。SCS可以造成葡萄糖代谢障碍、血脂异常、高血上腺轴(hypothalamic-pituitary-adrenal axis,HPA)轻压、骨脆性增高、亚临床动脉粥样硬化、内脏脂肪堆度异常造成的皮质醇增多，而没有特异的、典型的库积、感染风险高、肌肉损伤、情绪障碍和高凝状态等，欣综合征临床表现，包括满月脸、中心性肥胖和皮肤但因无典型库欣综合征症状而在临床工作中容易被
