肾上腺节细胞神经瘤的超声表现

目的：探讨肾上腺节细胞神经瘤的特征性超声表现,以提高其诊断的准确性。方法：回顾分析18例经手术与病理证实为节细胞神经瘤的超声检查资料。12例仅行灰阶超声检查,6例行灰阶及彩色多普勒超声检查。超声检查观察并记录肿块的部位,大小,回声,边界,有无包膜及钙化。彩色多普勒记录血流形态,测量阻力指数,观察肿瘤与周围血管及脏器的关系。结果：手术证实的18例肾上腺节细胞神经瘤中,14例位于右侧肾上腺,4例位于左侧肾上腺。超声检出16例（检出率88．9％）,其中右侧13例,左侧3例。最大肿块90mm×80mm×25mm,最小肿块35mm×18mm×6mm。16例中5例见强或高回声,伴后方回声衰减,病理证实有钙化。彩色多普勒超声检查示3例肿块内见点状血流,3例肿块未测及血流。1例超声诊断为肾上腺恶性肿瘤,其余诊断为肾上腺良性肿瘤。结论：节细胞神经瘤的超声表现有一定的特异性,观察肿瘤内有无钙化灶以及嵌入式生长,将有助于该肿瘤的诊断。     

肾上腺节细胞神经瘤8例螺旋CT诊断分析

目的：探讨肾上腺节细胞神经瘤的螺旋CT表现及诊断价值。方法：回顾性分析8例经手术病理证实的肾上腺节细胞神经瘤患者的螺旋CT表现、临床病理资料并结合相关文献,讨论其CT影像特征。结果：8例肿块呈类圆形、椭圆形及不规则形,边界清晰,密度较均匀,2例肿块内见多发或单发细小斑点状钙化。4例肿块最大径在5 cm以上者,肿瘤受邻近器官及血管不同程度挤压而呈铸形生长。增强扫描肾皮质期肿块无明显强化,肾实质期轻度强化,强化程度5~15 Hu。结论：嵌入性铸形生长、细小钙化、轻度延迟强化及肿块无明显坏死囊变为肾上腺节细胞神经瘤的螺旋CT表现特征,有重要的诊断价值。     

肾上腺节细胞神经瘤彩色多普勒超声及超声造影表现

目的 探讨肾上腺节细胞神经瘤的彩色多普勒超声及超声造影征象,提高术前诊断准确性.方法 回顾性分析经病理证实的24例肾上腺节细胞神经瘤的彩色多普勒超声及超声造影表现.结果 24例肾上腺节细胞神经瘤均行彩色多普勒超声检查,大多表现为体积较大、边界清晰、类圆形或椭圆形、低回声、回声分布较均匀的肿块,4例呈长条形,1例有囊性变,50％可见点状钙化,彩色多普勒多不能探及血流信号.9例进行了超声造影,注入超声造影剂后,4例病灶基本无灌注,5例有造影剂灌注(4例呈弱灌注,1例中等灌注),造影剂到达时间为16～25S.结论 肾上腺节细胞神经瘤的彩色多普勒超声表现特异性不高,超声造影可为其与肾上腺侵袭性病变的鉴别提供一定信息.     

嗜铬细胞瘤的超声诊断进展

肾上腺肿块可分为非肿瘤性肿块和肿瘤性肿块。非肿瘤性肿块常见有:肾上腺皮质增生、肾上腺出血、肾上腺结核、肾上腺囊肿等。肿瘤性肿块按其组织起源一般为三大类:(1)皮质常见肿瘤有:醛固酮瘤、库欣瘤、皮质腺瘤和皮质癌等;(2)髓质常见肿瘤有:嗜     

神经束膜瘤的超声图像特征分析

目的 分析总结神经束膜瘤超声图像特征。方法 回顾性分析13例神经束膜瘤患者的超声图像特征。结果 神经内神经束膜瘤超声图像为神经“纺锤状”增大，跨度较长，肿瘤内部维持了神经结构，长轴及横断面均可见低回声的神经束增粗明显；软组织神经束膜瘤超声图像表现为软组织内椭圆形低回声区，形态规则，边界清晰，内部回声均质。结论 神经内神经束膜瘤的超声图像有一定特征性，能为临床诊断指明方向；软组织神经束膜瘤超声图像表现没有特异度。     

肾上腺节细胞神经瘤的超声诊断

目的探讨肾上腺节细胞神经瘤的超声表现,提高对该病的认识。方法回顾性分析18例肾上腺节细胞神经瘤的超声表现,观察肿瘤位置、大小、形态、边界、内部回声、彩色血流信号以及肿瘤与周围血管及脏器的毗邻关系。结果所有肿瘤均为单发,最大径为1.9-11.0 cm,肿瘤均呈低回声,边界清晰,内部无液化坏死。22.2%（4/18）形态规则,77.8%（14/18）形态不规则,其中33.3%（6/18）可见肿瘤呈嵌入性生长,72.2%（13/18）肿瘤内见少量或多个点状钙化,CDFI示27.8%（5/18）肿瘤内见少量点状彩色血流,72.2%（13/18）未见彩色血流。结论肾上腺节细胞神经瘤在声像图上呈现一定的特征性表现,观察其形态及内部钙化灶可有助于诊断。     

超声显像在肾上腺转移癌诊断中的应用价值

目的 探讨超声显像对肾上腺转移癌的诊断价值。方法 回顾性分析近二十年来我院经超声显像检查并经手术与病理证实的29例肾上腺转移癌患者的声像图特点。结果 29例肾上腺转移癌声像图显示肿块直径为1．8～10．3cm，肿块呈不规则形者18例，呈椭圆形者11例；肿块内部回声分布不均匀，呈低回声者11例，弱回声6例，较高回声4例，弱、低回声与较高回声混合者8例；超声显像诊断与手术和病理诊断相符者27例，符合率为93．1％（27／29）。结论 肾上腺转移癌具有一定的超声声像罔特征，超声显像对肾上腺转移癌的诊断具有重要临床应用价值，可作为临床诊断的首选方法。     

颅内肿瘤的术中超声成像及技术应用

目的探讨颅内肿瘤的术中超声成像特征和超声的技术应用。方法对48例原发颅内肿瘤和转移瘤进行术中实时超声成像，分析不同类别肿瘤的回声形态。结果48例颅内肿瘤均为不同于周围脑组织回声性质的病变而被准确识别和定位。实质性低级别胶质瘤以规则的脑沟为边界，中心性坏死在高级别胶质瘤中最常见，随胶质瘤级别的增高，回声的不均匀性增加；脑膜瘤表现为边界清晰的均匀高回声，术中超声可显示窦旁脑膜瘤对静脉窦的压迫或侵犯；海绵状血管瘤表现为边界清楚的实质性的高回声团块，可检出的最小直径为9mm；转移瘤表现为强回声环和不均匀的回声中心。瘤周水肿的信号强度介于肿瘤和脑组织之间。结论术中超声能为颅内肿瘤的准确定位和描述细节提供有价值的信息，合理应用神经超声技术可使病变成像更清晰。     

肾上腺少见肿瘤CT表现

目的 回顾性总结肾上腺少见肿瘤的CT表现特征,以提高诊断水平.方法 回顾性分析16例经手术和病理证实的肾上腺少见肿瘤,观察其CT表现特征.结果 16例中,肾上腺节细胞神经瘤3例,均匀较低密度,轻度强化;肾上腺血管瘤及肾上腺神经鞘瘤各2例,密度混杂,增强扫描肾上腺血管瘤不均匀明显强化,肾上腺神经鞘瘤呈轻至中度强化;肾上腺淋巴瘤4例,单侧或双侧较均匀密度软组织肿块,增强扫描具有延迟强化特点,肿瘤较大者周围血管可被包埋;肾上腺皮质癌5例,单侧密度不均匀软组织肿块,增强扫描见肿瘤血管影及邻近脏器受侵犯、下腔静脉癌栓、腹膜后淋巴结转移等恶性征象.结论 肾上腺少见肿瘤各具有一定的CT表现特点及诊断价值.     

腱鞘巨细胞瘤的高频彩色多普勒超声表现特征

目的总结腱鞘巨细胞瘤的声像图特征，探讨高频彩以多普勒超声对腱鞘巨胞瘤的诊断价值。方法总结分析了37例经手术病理证实的腱鞘巨细胞瘤的二维和彩色多普勒超声特征。结果腱鞘巨细胞瘤声像图及血流图特征：1、指、趾等关节或肌腱旁实性低回声肿块，大部分回声均匀，少部分可见钙化及液化，巨方回声增强：2、肿瘤无包膜回声，与周围组织分界清晰；可压迫骨质和健及关切囊；3、多数瘤体内可探及丰富血流信号。结论 高频彩色普勒超声可作为腱鞘巨细胞瘤的首选检查手段之一。     

彩色多普勒超声对肾上腺肿瘤的诊断价值

目的 探讨彩色多普勒超声对肾上腺肿瘤的定位及定性诊断价值.方法 对102例临床疑有肾上腺肿瘤的住院患者行彩色多普勒超声与增强CT前瞻性对照研究,并分析不同类型肾上腺肿瘤的超声表现.结果 102例患者中,术后病理证实94例为肾上腺肿瘤,3例为肾上腺囊肿,2例为肾上腺皮质增生,2例为肾上极肿瘤,1例为副脾.彩色多普勒超声与增强CT的定位诊断正确率分别为92.2%(94/102)、96.1%(98/102),定性诊断正确率分别为87.2%(82/94)、89.4%(84/94),两者比较差异均无统计学意义(P均＞0.05).94例肾上腺肿瘤中,超声检出89例,病理证实良性肿瘤64例,恶性肿瘤25例,主要为皮质腺瘤、嗜铬细胞瘤及转移癌,分别占40.4%(36/89)、21.3%(19/89)、14.6%(13/89).肾上腺皮质腺瘤体积较小,主要表现为低回声与等回声,嗜铬细胞瘤与转移癌体积较大,内部回声不均匀,常出现液化坏死,其他肾上腺肿瘤如皮质癌与神经母细胞瘤主要表现为不均匀回声,髓样脂肪瘤均表现为高回声.彩色多普勒超声显示,仅17例(17/64)良性肿瘤可探及较丰富血流信号,相反20例(20/25)恶性肿瘤可探及较丰富血流信号.结论 彩色多普勒超声对肾上腺肿瘤的定位与定性诊断正确率高,是诊断肾上腺肿瘤的可靠方法.     

肾上腺肿瘤声像图特征在判断良恶性质中的价值

目的探讨二维和彩色多普勒超声在判断肾上腺良、恶性肿瘤中的价值。 方法回顾性分析96例肾上腺良、恶性肿瘤的声像图特征,并与病理诊断对照。 结果肾上腺肿瘤声像图为;（1）低回声;（2）等回声;（3）高回声;（4）混合性回声;（5）囊性回声。 结论肾上腺肿瘤越大,其恶性的可能性也越大。超声检查对判断肾上腺良、恶性肿瘤有重要价值。较大肿瘤中探测到钙化灶或丰富的血流,应怀疑肾上腺恶性肿瘤。     

肾上腺恶性肿瘤的超声诊断价值

目的 探讨超声对肾上腺恶性肿瘤的诊断价值.方法 回顾性研究21例肾上腺恶性肿瘤患者的临床及超声资料,观测肿瘤的位置、大小、形态、回声及彩色血流信号,肿瘤与周围血管、脏器的毗邻关系等.结果 21例肾上腺恶性肿瘤中,肿瘤直径最大17.0 cm,最小2.5 cm.其中肾上腺皮质腺癌10例,肾上腺恶性嗜铬细胞瘤4例,神经母细胞瘤瘤和神经节母细胞瘤4例,肾上腺血管源性肉瘤1例,恶性纤维组织细胞瘤1例,转移性黏液腺癌1例.不同病理性质的肾上腺恶性肿瘤的声像图表现有一定差异:肾上腺皮质癌检出时体积相对较大;肾上腺神经母细胞回声不均匀,瘤内有多发点状强回声且血供丰富.超声共检出肾上腺恶性肿瘤20例,漏诊1例.结论 各类肾上腺恶性肿瘤的声像图具有一定的特征性表现,超声是诊断肾上腺恶性肿瘤有效的影像学检查方法,在临床上具有实用价值.     

胎儿肾上腺囊性病变的超声观察

目的 评价胎儿肾上腺囊性病变的超声诊断价值.方法 回顾性分析我院21例产后经手术或穿刺活检证实的胎儿期肾上腺囊性病变的超声影像资料,并与产后新生儿期超声随访资料进行比较.结果 21例胎儿期肾上腺囊性病变,超声表现无回声15例,斑片状混合回声6例;产后新生儿期无回声10例,混合回声11例;产后病理证实单纯性囊肿10例.囊肿内出血5例,自发性肾上腺出血6例.结论 胎儿期肾上腺囊性病变的声像图特征可以为临床产前诊断该类疾病提供有意义的诊断信息.     

原发性肾上腺皮质功能减退症20例临床分析

目的 探讨原发性肾上腺皮质功能减退症的临床特点及诊疗措施。方法 对20例原发性肾上腺皮质功能减退症患者的临床资料进行回顾性分析。结果 20例患者中13例为结核性，5例为特发性，2例为肾上腺切除术后；临床表现中以皮肤色素沉着较特异；非特异性症状出现早，且较常见。确诊有赖于皮质醇测定及快速促肾上腺皮质激素兴奋试验，其他激素及生化指标也有改变。结核性患者肾上腺CT以增生、钙化为主要表现。结论 确诊后给予泼尼松替代治疗，应激状态下应加大剂量，避免发生危象。     

Acute adrenal insufficiency after a single dose of etomidate

Acute adrenocortical insufficiency is a critical care emergency characterized by hemodynamic instability, lethargy, and cardiovascular collapse. Acute adrenal insufficiency has many etiologies, from rapid withdrawal of exogenous glucocorticoids to adrenocortical destruction to poor adrenal reserve after administration of steroid synthesis inhibitors. Etomidate, a parenteral hypnotic agent, is a steroid synthesis inhibitor. Although the use of continuous etomidate infusion in the intensive care unit fell from favor secondary to reports of adrenal crisis, single-dose etomidate for induction of anesthesia is common for the hemodynamically unstable patient or in patients who may not tolerate wide variance in heart rate or blood pressure. A case is presented of acute adrenocortical insufficiency and crisis after a standard induction dose of etomidate. Acute adrenal insufficiency should be suspected in intensive care unit patients who have undergone general anesthesia with etomidate induction and present with hypotension refractory to standard vasopressor administration.     

Molecular adrenocortical tumourigenesis

Adrenocortical neoplasms are the most frequent abnormality of the adrenal cortex. Most of these lesions are clinically silent and are detected incidentally by ultrasound or computed tomography. The prevalence of these so-called 'incidentalomas' in the general population is around 1%, increasing with age and reaching 6% among those in the age range 60–70 years. In contrast, primary adrenocortical carcinoma, a highly malignant tumour, is rare, having an incidence of one case per million per year. Recent progress has been achieved in the understanding of adrenocortical tumourigenesis by mapping and identification of genes responsible for hereditary tumours that involve the adrenal gland. Investigation of the clonal composition of adrenal tumours demonstrates that adrenal carcinomas are monoclonal, whereas adrenal adenoma may be polyclonal in approximately 25–40% of cases. Oncogenes and tumour-suppressor genes involved in adrenal carcinomas include mutations in the p53 tumour-suppressor gene and rearrangements of the chromosomal locus 11p15.5 associated with IGF II hyperexpression. Constitutive activation of the ACTH receptor-G protein-cAMP signal cascade does not play a role in adrenal tumour formation. Conversely, deletions of the ACTH receptor gene have recently been found in undifferentiated adenomas and in aggressive adrenocortical carcinomas, and, more recently, confirmed in a larger series of tumours. The available literature indicates that the signalling pathways of adrenocortical tumours are different from those of other endocrine neoplasms, such as pituitary and thyroid adenomas.     

Primary aldosteronism due to bilateral micronodular hyperplasia and concomitant subclinical Cushing’s syndrome: A case report

BACKGROUNDAdrenal incidentaloma (AI) has been frequently encountered in the clinical setting. It has been shown that primary aldosteronism (PA) or subclinical Cushing’s syndrome (SCS) are the representative causative diseases of AI. However, the coexistence of PA and SCS has been reportedly observed. Recently, we encountered a case of AI, in which PA and SCS coexisted, confirmed by histopathological examinations after a laparoscopic adrenalectomy. We believe that there were some clinical implications in the diagnosis of the present case.CASE SUMMARYA 58-year-old man presented with lower right abdominal pain with a blood pressure of 170/100 mmHg. A subsequent computed tomography scan revealed right ureterolithiasis, which was the cause of right abdominal pain, and right AI measuring 22 mm × 25 mm. After the disappearance of right abdominal pain, subsequent endocrinological examinations were performed. Aldosterone-related evaluations, including adrenal venous sampling, revealed the presence of bilateral PA. In addition, several cortisol-related evaluations showed the presence of SCS on the right adrenal adenoma. A laparoscopic right adrenalectomy was then performed. The histopathological examination of the resected right adrenal revealed the presence of a cortisol-producing adenoma, while CYP11B2 immunoreactivity was absent in this adenoma. However, in the adjacent non-neoplastic adrenal, multiple CYP11B2-positive adrenocortical micronodules were detected, showing the presence of aldosterone-producing adrenocortical micronodules. CONCLUSIONCareful clinical and pathological examination should be performed when a patient harboring AI presents with concomitant SCS and PA.     

Stimulatory effect of prolactin on the mitotic activity of the adrenal cortex in snell mice with hereditary dwarfism

Effects of thyrotropin (TSH), growth hormone (GH), prolactin (Prl), and ACTH on the proliferation of adrenocortical cells in male Snell dwarf mice and in phenotypically normal male mice from the same strain were examined by means of the colchicine metaphase-arrest technique. After 6 days of treatment, ACTH increased significantly the mean mitotic activity rate (MMAR) of adrenocortical cells in both the normal (nondwarf) and dwarf mice as compared to the corresponding control groups receiving physiologic saline. None of the remaining examined pituitary hormones did exert a mitogenic action on the adrenal cortex of normal mice. It was, however, recorded the significant elevation of the MMAR of the adrenocortical cells in Prl-treated Snell dwarf mice, while TSH and GH did not stimulate mitogenesis. The acquired data corroborates a well-known proliferogenic effect of ACTH on the adrenal cortex in vivo. The increase of the MMAR of the adrenal cortex of Snell dwarfs following Prl-treatment is in agreement with earlier reports.     

肾上腺肿瘤的CT影像定性分析（附57例）

本文报道57例经手术及病理证实的肾上腺肿瘤的CT资料,包括肾上腺皮质腺瘤31例、嗜铬细胞瘤17例、原发性皮质腺癌8例、髓质脂肪瘤1例。分析肾上腺各类病变的CT表现,讨论对各类病变的定性诊断。认为CT扫描可以从综合病灶大小、形态、范围、密度等方面较明确地对肾上腺肿瘤作出定性诊断。