中国肾上腺衰老诊疗专家共识(2025版)

doi:10.3969/j.issn.1003-9198.2026.04.020

摘要/Abstract

摘要： 肾上腺衰老(adrenal aging)是指随年龄增长而出现的肾上腺结构与功能的渐进性改变,尤其表现为肾上腺皮质分泌谱的重塑:脱氢表雄酮(DHEA)及其硫酸酯(DHEAS)显著下降,醛固酮平均水平下降而皮质醇总体维持相对稳定或轻度升高,昼夜节律与分泌脉冲振幅减弱。这些激素改变与肌少症/骨量减少、代谢综合征、血压异常、免疫功能下降、情绪与认知障碍、衰弱与康复能力下降等多系统不良结局存在关联,提示肾上腺衰老是值得重视的临床问题。然而,迄今国内尚无关于“肾上腺衰老/肾上腺皮质衰老”的统一共识或指南。本共识在系统检索证据基础上,结合我国临床实践,首次提出肾上腺衰老的定义、诊断评估路径、实验室与影像学检测建议、鉴别诊断要点、分层管理与干预策略及随访规范,旨在规范我国肾上腺衰老的临床诊治与科研实践,促进健康老龄化。

关键词: 肾上腺, 衰老, 肾上腺皮质, 皮质醇, 醛固酮, 昼夜节律, 衰弱

Abstract: Adrenal aging refers to the progressive structural and functional changes of the adrenal glands that occur with advancing age, particularly characterized by a remodeling of the adrenal cortical secretory profile with a marked decline in dehydroepiandrosterone (DHEA) and its sulfate (DHEAS), a decrease in average aldosterone levels, and overall cortisol levels that remain relatively stable or are mildly elevated, with attenuation of circadian rhythms and secretory pulse amplitudes. These hormonal changes are associated with adverse outcomes across multiple systems, including sarcopenia/osteopenia, metabolic syndrome, blood pressure abnormalities, impaired immune function, mood and cognitive disorders, frailty, and reduced rehabilitation capacity, indicating that adrenal aging is a clinical issue warranting attention. However, there has been no unified national consensus or guideline in China on adrenal aging/adrenocortical aging to date. Based on a systematic review of the evidence and aligned with domestic clinical practice, this consensus for the first time proposes the definition of adrenal aging, pathways for diagnostic evaluation, recommendations for laboratory and imaging tests, key points for differential diagnosis, stratified management and intervention strategies, and follow-up standards, with the goal of standardizing clinical diagnosis, treatment, and research practice related to adrenal aging in China and promoting healthy aging.

Key words: adrenal gland, aging, adrenal cortex, cortisol, aldosterone, circadian rhythm, frailty

中图分类号:

肾上腺衰老专家共识组成员, 中国康复医学会老年医学分会. 中国肾上腺衰老诊疗专家共识(2025版)[J]. 实用老年医学, 2026, 40(4): 433-444.

Expert Consensus Panel on Adrenal Aging, Geriatric Medicine Branch, Chinese Association of Rehabilitation Medicine. Expert consensus on the diagnosis and management of adrenal aging in China (2025 Edition)[J]. Practical Geriatrics, 2026, 40(4): 433-444.

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