肾上腺意外瘤的诊治进展

Advance in diagnosis and treatment of adrenal incidentalomas

肾上腺意外瘤(adrenal incidentalomas,AI)检出率呈逐年升高趋势。AI需多学科联合诊疗,初诊AI时必须逐一评估良恶性质及内分泌功能水平。多数AI患者无主观症状,需通过影像学检查判断其良恶性质,平扫CT<10 Hu且<4 cm者恶性率低。午夜1 mg地塞米松抑制试验的血清皮质醇水平≤50 nmol/L(≤1.8μg/d L)作为排除自主皮质醇分泌的诊断标准。分子生物学诊断的联合应用对于患者治疗方案的选择和预后评估价值凸显。临床治疗需进一步研究。AI的诊断和治疗需要多学科联合,建议至少每5年随访必须进行影像学及内分泌功能评估。

The detection rate of adrenal incidentalomas is increasing annually. AI needs multidisciplinary diagnosis and treatment, and the nature and endocrinological level must be evaluated. There is no clinical symptom in most AI patients. Therefore, the imaging and endocrine function tests have great roles. Imaging with an adrenal mass below 4cm in size with CT 〈 10Hu suggests dear benign feature. The 1-mg overnight dexamethasone suppression test （1 mg DST） for all patients with newly diagnosed AI suggests a normal hormonal secretion （i.e., 1 mg DST 〈 1.8 mg DST）. Molecular biology methods are of great value in the choice of treatment options and prognostic evaluation. Other adjuvant therapies need further studies. In conclusion, the diagnosis and treatment on AI meet multidisciplinary assessment. We suggest biochemical and morphological follow-up for M patients at least every 5 years.