568例肾上腺肿物临床回顾性分析

Clinical Retrospective Analysis of 568 Adren-al Mass

目的:分析肾上腺肿物疾病谱的变化趋势及临床特点,尤其是肾上腺意外瘤(Adrenal Incidentaloma, AI)的病因构成及临床特点。方法:回顾性分析2012年1月至2022年12月于石河子大学第一附属医院经手术病理证实的肾上腺肿物患者568例的病例资料,包括性别、年龄、既往史、就诊原因、临床症状、实验室指标、影像学资料、术后病理及免疫组化等。结果:1) 568例肾上腺肿物患者中,465例完善了内分泌功能评估,按有无功能进行分组,功能性肿瘤中原发性醛固酮增多症(primary aldosteronism, PA)居于首位(53.9%),无功能性肿瘤中的无功能腺瘤占比最高(69.8%);2) 与无功能瘤组相比,功能性肿瘤组BMI、肿瘤大小、SBP、DBP、血钠、平扫及增强期CT值偏高(均P < 0.05),而年龄、血钾、GFR偏低(均P < 0.05)。3) 568例肾上腺肿物中共发现243例AI患者,其中188例完善激素评估,居于首位的是无功能瘤(38.3%),其次为PA (25.5%);4) 188例AI按是否合并高血压进行分组,合并高血压组年龄、BMI、嗜铬细胞瘤(pheochromocytoma, PCC)、库欣综合征(Cushing’s syndrome, CUS)、PA均高于血压正常组(均P < 0.05),而血钾、GFR低于血压正常组(均P < 0.05)。结论:肾上腺肿物检出率逐渐增加,其中近半数患者为AI患者,临床医生加强对疾病认识的同时,应规范其诊疗流程,避免功能性肿瘤的漏诊和误诊。

Objective: To analyze the disease spectrum trend and clinical characteristics of adrenal mass, espe-cially the etiology and clinical characteristics of AI. Methods: Retrospective analysis of the case data of 568 patients with adrenal masses confirmed by surgery and pathology in the First Affiliated Hos-pital of Shihezi University from January 2012 to December 2022, including gender, age, past history, medical reasons, clinical symptoms, laboratory indicators, imaging data, postoperative pathology and immunohistochemistry. Results: 1) Among the 568 patients with adrenal mass, 465 improved the endocrine function assessment and grouped according to the presence of function. Among func-tional tumors, PA was the first (53.9%), and the proportion of non-functional adenomas was the highest (69.8%). 2) Compared with the nonfunctional tumor group, BMI, tumor size, SBP, DBP, blood sodium, plain scan, and enhanced CT values were higher (all P < 0.05), while age, blood potas-sium, and GFR were lower (all P < 0.05). 3) A total of 243 AI patients were found in 568 adrenal masses, of which 188 patients were nonfunctional tumors (38.3%), followed by PA (25.5%);4) 188 AI cases were grouped by hypertension, with hypertension, age, BMI, Pheochromocytoma (PCC), Cushing’s syndrome (CUS) and PA were higher than the normotensive group (all P < 0.05), while serum potassium and GFR were lower than the normotensive group (both P < 0.05). Conclusion: The detection rate of adrenal mass is gradually increasing, and nearly half of the patients are AI patients. While clinicians strengthen their understanding of the disease, they should standardize their diag-nosis and treatment procedures to avoid the missed diagnosis and misdiagnosis of functional tu-mors.