肾上腺皮髓质混合性病变误诊4例报告

肾上腺皮质和髓质由于起源不同,其病变往往独立发生,皮髓质混合性病变较为罕见。本文报告4例肾上腺皮髓质混合病变患者的临床资料。4例病人CT检查肾上腺均发现异常,术前误诊原发性醛固酮增多症3例,嗜铬细胞瘤1例。4例均行单侧肾上腺全切除,3例痊愈,1例术后15年复发,考虑对侧有病变。术后病理报告均为肾上腺皮髓质混合病变。在临床上若发现肾上腺疾病有原醛症的表现,同时又有儿茶酚胺症的特点时,要考虑肾上腺皮髓质混合病变的可能。围手术期应按儿茶酚胺症准备,确诊靠病理检查。

Misdiagnosis of corticomedullary mixed pathological changes in adrenals: report of 4 cases

Pathological changes usually occur independently in the adrenal cortex and medulla because of their distinct embryonic origins, and changes involving both the cortex and medulla are rare. We report 4 cases of corticomedullary mixed pathological changes adrenal glands. CT scanning of the adrenal glands showed unilateral abnormalities in all the 4 cases, 3 of which were diagnosed as aldosteronism and the other pheochromocytoma before surgery. Unilateral adrenalectomy was performed in the 4 patients 3 being cured and discharged. The other 1 had recurrence 18 months postoperatively with suspected pathological changes on the other side. Subsequent pathological examination confirmed the suspicion in both the cortex and medulla of the other adrenal gland. In cases with clinical presentations as simultaneous onset of aldosteronism and catecholamine responses, pathological changes in both the cortex and medulla of the adrenal glands should be considered. Perioperative management of such cases should be the same as that in cases of catecholamine responses, and the diagnosis relies on histopathological examination.