1173例肾上腺意外瘤病因构成分析

Etiologies of 1 173 hospitalized cases with adrenal incidentaloma

目的 总结肾上腺意外瘤患者的病因构成特点.方法 收集自1993年1月至2013年7月在解放军总医院内分泌科住院诊治的肾上腺意外瘤患者的病历资料,包括性别、年龄、入院日期、意外瘤首诊原因、临床诊断、是否手术、术后病理诊断、影像学资料等,进行回顾性分析.结果（1）共1 173例患者,其中男629例（53.62%）,女544例（46.38%）,男∶女=1.16：1,平均就诊年龄（50.84±12.13）岁.其中合并高血压者669例（57.03%）.行手术治疗者622例.（2）常规体检是意外瘤患者的主要首诊原因[498例（42.46%）],其次是腹部不适140例（11.94%）,274例（23.25%）的患者在高血压、糖尿病、冠心病等慢性疾病住院诊治过程中意外发现肾上腺占位.（3）病因构成方面,肾上腺无功能瘤居于首位,为809例（68.97%）;功能性肿瘤中,嗜铬细胞瘤居于首位,为137例（11.68%）,其次是原发性醛固酮增多症84例（7.16%）和肾上腺性库欣综合征65例（5.54%）;恶性肿瘤中,肾上腺皮质癌和转移癌分别为20例（1.70%）、16例（1.36%）.（4）与血压正常组相比,合并高血压组肾上腺无功能瘤比例明显较低（P＜0.05）,而肾上腺性库欣综合征、原发性醛固酮增多症比例明显较高（均P＜0.05）.结论 近年来肾上腺意外瘤检出率逐渐上升,其中合并高血压者较为常见;在病因构成方面,居于首位的是无功能瘤,功能性肿瘤中依次是嗜铬细胞瘤、原发性醛固酮增多症和肾上腺性库欣综合征.

Objective To summarize the characteristics of etiological distribution of adrenal incidentaloma during the past 20 years. Methods All the relevant data of adrenal incidentaloma patients admitted into Chinese PLA General Hospital between January 1993 and January 2013 were collected. Their gender ratio, visiting ages and final diagnoses were retrospectively analyzed. Results There were 1 173 patients were collected, of which, 629 （53.62%） males and 544 （46. 38% ） females with a mean age of （50. 84 ＋ 12. 13 ） years. There were 669 （ 57.03% ） hypertensive cases and 622 cases undergone adrenalectomy. Routine medical checkup and abdominal discomfort led to the discovery of adrenal incidentalomas. As to the etiologies, there were non-functional tumors （n = 809, 68.97% ）, pheochromocytoma （n = 137, 11.68% ）, primary aldosteronism （n = 84, 7.16% ） and adrenal Cushing syndrome （n = 65, 5.54% ）. The proportions of adrenal cortical carcinomas and metastases were 1.70% （n = 20） and 1.36% （ n = 16 ） respectively. Compared with normotension group, the proportion of non- functional lesions in hypertension group was significant lower （73.81% vs 65.32%, P 〈 0. 05 ） while the proportions of primary aldosteronism and adrenal Cushing syndrome were higher （11.96% vs 0.79%, 5. 83% vs 5. 18%, both P 〈 0. 05 ）. Conclusion Adrenal ineidentaloma patients with concurrent hypentension is quite common. In respect of etiologies, non-functional tumor is the most common and followed by pheoehromocytoma and primary aldosteronism Cushing syndrome.