肾上腺偶发瘤临床分析

Clinical analysis of 97 cases of adrenal incidentaloma

目的总结肾上腺偶发瘤的临床、内分泌及病理学特点。方法回顾性分析97例病理确诊肾上腺偶发瘤患者的临床资料。男53例，女44例。平均年龄45岁。肿瘤位于左侧38例、右侧52例、双侧7例。有较完整内分泌检测资料者74例。肿瘤最大直径由B超确定8例、CT确定54例、MRI确定35例。结果97例中恶性肿瘤20例（20．6％），其中。肾上腺皮质癌12例、恶性嗜铬细胞瘤3例、转移癌2例，肉瘤、神经母细胞瘤、恶性神经鞘瘤各1例；肾上腺皮质腺瘤26例（26．8％），良性嗜铬细胞瘤21例（21．6％），髓脂肪瘤9例（9．3％），肾上腺囊肿13例（13．4％），节细胞神经瘤5例（5．2％），神经纤维瘤3例（3．1％）。高血压病患者40例（41．2％），功能性偶发瘤21例（28．4％）。肿瘤直径〈4cm者25例（25．8％）、4～6cm者33例（34．0％）、〉6cm者39例（40．2％）。肿瘤直径〈4cm者中恶性肿瘤仅1例（4％）。恶性肿瘤直径（9．9±4．6）cm，良性肿瘤直径（5．6±3．2）cm（P=0．01）。恶性肿瘤中直径〉6cm者15例（75．0％），良性肿瘤中27例（35．1％，P=0．001）。恶性肿瘤患者体质量减轻者5例（25．0％），良性肿瘤者中2例（2．6％，P=0．004）。结论肾上腺偶发瘤中皮质腺瘤、良性嗜铬细胞瘤和恶性肿瘤居前3位，偶发瘤均应进行详细的内分泌检测，肿瘤直径〈4cm是筛选无内分泌异常的偶发瘤随访时的一项重要指标。

Objective To evaluate the clinical, endocrinological and pathological characteristics of adrenal incidentaloma. Methods Ninety-seven patients （53 males and 44 females） diagnosed with adrenal incidentaloma confirmed by pathology were retrospectively analyzed in this study. The mean patient age was 45 years old. Thirty-eight cases had left adrenal lesions, 52 cases had right adrenal lesions and 7 cases had bilateral adrenal tumors. Of these patients, 74 cases had accepted full range en docrinological investigations. The tumor size was measured by ultrasonography （US） in 8 cases, CT scanning in 54 cases and MRI in 35 cases, respectively. Results Of these 97 adrenal incidentalomas, 20 cases（20.6 %） were malignant tumors （12 adrenocortical carcinomas, 3 malignant pheochromocytomas, 2 metastatic cancers, 1 sarcoma, 1 neuroblastoma and 1 malignant schwannoma）, 21 cases （21.6%） were benign pheochromocytomas, 26 cases（26. 8%） were adrenal adenomas, 9 cases （ 9.3 % ） were myelolipomas, 13 cases（ 13.4 % ） were adrenal cysts, 5 cases （5.2% ） were ganglioneuro- ma and 3 cases（3.1%） were neurofibroma. Endocrinological study showed that 21 （28.4 %） of the incidentalomas were functional. Forty patients（41.2%） had hypertension. Tumor size less than 4 cm in diameter were found in 25.8%cases,tumor size ranged from 4 to 6 cm were found in 34.0% cases and tumors larger than 6 cm were found in 40.2 % cases. The average diameter of malignant tumors was 9.9±4.6 cm which was significantly larger than the average diameter of benign tumors（ 5.6±3.2 cm （P=0.01）. Tumor size greater than 6 cm was more frequently found in patients with malignant tumor （75.0% vs 35.1%, P=0. 001）. Only 4% of the incidentalomas less than 4 cm selected surgery were malignant tumors. Weight loss was more frequently found in patients with malignant tumor than that in benign tunor（25.0% vs 2.6%, P=0. 004）. Conclusions Adrenal adenomas, benign pheochro-mocytomas and malignant tumors are the main types of adrenal incidentaloma. The endocrinologicai evaluation should be performed in all adrenal incidentalomas. In patients with normal endocrinological study, tumor size less than 4 cm is an important characteristic for benign tumors.