肾上腺偶发瘤52例临床分析

Adrenal incidentalomas:clinical analysis of 52 cases

目的提高肾上腺偶发瘤早期诊断与鉴别诊断水平,指导临床治疗。方法本组52例均为健康体检发现的肾上腺偶发瘤。男35例,女17例,年龄23～65岁,平均42岁。均无高血压及内分泌紊乱的临床症状和体征。肿瘤直径≥3.0cm者33例。52例均行血生化、电解质检查,肾上腺皮、髓质代谢的生化检测及腹部超声、CT检查;6例行MRI检查,2例行PET检查,1例行肾上腺131IMIBG核素扫描。52例均行手术治疗。结果肾上腺偶发瘤52例经病理证实皮质腺瘤27例,转移瘤7例,嗜铬细胞瘤5例,囊肿4例,原发性醛固酮瘤3例,神经鞘瘤2例,皮质癌1例,腹膜后神经母细胞瘤1例,腹膜后原发性淋巴瘤1例,神经节纤维瘤1例。影像学及实验室检查术前获正确诊断者14例(27%)。10例恶性肿瘤者中,5例肾上腺转移瘤者术后行化疗,6～10个月内死亡,余5例失访。42例良性病变者随访6个月～9年,未见肿瘤复发。结论肾上腺偶发瘤术前定性诊断困难,应积极手术治疗。

Objective To improve the diagnosis and differential diagnosis of adrenal incidentalomas for the optimal management of adrenal masses. Methods The clinical data of 52 cases (35 men and 17 women;mean age,42 years;age range,23-65 years) of adrenal incidentalomas was reviewed.Among them, 33 cases had tumors ≥ 3.0 cm in diameter.None of 52 cases had clinical symptoms and signs of hypertension and endocrine dysfunction.All of the tumors were incidentally found by ultrasonography or CT on regular physical examination.A series of blood chemical examinations (including electrolytes,adrenal cortical and medullary metabolic biochemistry),abdominal ultrasound and CT were performed in all 52 cases;and MRI,PET and  131 I-MIBG imaging were performed in 6,2 and 1 cases,respectively.Surgery and postoperative pathological study were performed in all. Results Postoperative pathology showed adrenocortical adenoma in 27 cases,adrenal metastatic carcinoma in 7,adrenal pheochromocytoma in 5,adrenal cyst in 4,primary aldosteronoma in 3,adrenal neurinoma in 2,adrenocortical carcinoma in 1,retroperitoneal neuroblastoma in 1,retroperitoneal primary lymphoma in 1 and adrenal ganglionic fibroma in 1.Diagnoses based on the results of imaging examinations and laboratory tests were correct in 14 cases (27%).Of the 10 patients with malignancies,5 with primary diseases died 6-10 months after chemotherapy and 5 were lost to follow-up.The remaining 42 patients were followed up for 6 months to 9 years with no evidence of recurrence. Conclusions Multidisciplinary approaches are required to identify and differentiate adrenal incidentalomas, and early surgical treatment is suggested.