488例肾上腺意外瘤住院患者临床特征及诊疗

Clinical research of 488 inpatients with adrenal incidentaloma

目的:分析肾上腺意外瘤(adrenal incidentaloma,AI)的临床特点和诊治现状。方法:回顾性分析2012年1月至2018年12月在北京大学第一医院住院,符合AI诊断标准的488例患者病例资料。结果:①488例AI患者中,326例(66.80%)为体检发现,409例(83.81%)为无功能占位;②180例经手术治疗的AI患者中,27例(15.00%)病理诊断为嗜铬细胞瘤,甲氧基去甲肾上腺素(normetanephrine,NMN)诊断效力曲线下面积为0.906,灵敏度为92.9%,特异度为81.6%,约登指数为0.745;计算机断层扫描(computed tomography,CT)联合血去甲肾上腺素、尿去甲肾上腺素诊断曲线下面积为0.828,敏感度为77.8%,特异度为85.3%,约登指数为0.631;③评估隔夜1 mg地塞米松抑制试验对亚临床库欣综合征(subclinical Cushing’s syndrome,SCS)的诊断价值,抑制后皮质醇最佳切点为2.1μg/dL,曲线下面积为0.967,敏感度为93.3%,特异度为92.4%,约登指数为0.857;④65例无功能AI随访半年至7年,2例进展为SCS;⑤31例<1 cm的肾上腺占位,仅2例(6.45%)为原醛症。结论:①2/3的AI为常规体检发现,是意外瘤发病率增加的主要原因,84%为无功能占位;②CT联合血、尿去甲肾上腺素诊断嗜铬细胞瘤的价值不及血NMN;③隔夜1 mg地塞米松抑制试验诊断SCS的最佳切点为2.1μg/dL,优于1.8μg/dL;④无功能AI有进展为亚临床库欣可能;⑤<1 cm的肾上腺占位功能评价意义不大,可能仅需影像学随访。

Objective:To analyze the clinical characteristics and current status of diagnosis and treatment of adrenal incidentaloma(AI).Methods:Clinical data of 488 patients admitted to Peking University First Hospital who met the AI diagnostic criteria from January 2012 to December 2018 were retrospectively analyzed.Results:①Of the 488 AI patients,326 cases(66.80%)were found during physical examination,409 cases(83.81%)were non-functional lesion.②There were 180 cases received surgical treatment,among which 27 patients(15.00%)were pathologically diagnosed as pheochromocytoma.The area under curve of blood normetane-phrine(NMN)in the diagnosis of pheochromocytoma was 0.906,with the sensitivity of 92.9%,the specificity of 81.6%,and the Youden’s index of 0.745.The area under curve of the joint test by computed tomography(CT),blood norepinephrine(NE)and urine NE was 0.828,with the sensitivity of 77.8%,the specificity of 85.3%,and the Youden’s index of 0.631.③To evaluate the diagnostic value of overnight 1 mg dexamethasone inhibition test for subclinical Cushing’s syndrome(SCS),the area under curve of the 1 mg overnight dexamethasone inhibition test in diagnosis of SCS was 0.967,the optimal cut-off point was 2.1μg/dL,with the sensitivity of 93.3%,the specificity of 92.4%,and the Youden’s index of 0.857.④A total of 65 patients of non-functional AI were followed up for 6 months to 7 years,and only 2 cases progressed to SCS.⑤There were 31 additional cases of adrenal mass<1 cm,and only 2 cases(6.45%)were primary aldosteronism.Conclusion:①Two thirds of AI was found by routine physical examination,which was the main reason for the increase of incidence of accidental tumor,and 84%of which was non-functional lesions.②The value of CT combined with blood NE and urine NE in the diagnosis of pheochromocytoma is lower than that of blood NMN.③The optimal cut-off point for the 1 mg overnight dexamethasone inhibition test diagnosis of SCS is 2.1μg/dL,which is better than 1.8μg/dL.④Non-functional AI may progress to SCS.⑤The clinical significance of adrenal lesions<1 cm function evaluation is unlikely to require,while imaging follow-up may be only required.