肾上腺偶发瘤的诊治

目的探讨肾上腺偶发瘤的诊断步骤和治疗方法的选择。方珐回顾性分析手术证实的129例肾上腺偶发瘤的临床资料。结果129例中125例完整切除肿瘤，肿瘤直径1．2—18cm。嗜铬细胞瘤31例，皮质腺瘤37例，皮质癌9例，转移癌4例，淋巴瘤3例，其他良性肿瘤45例。结论肾上腺偶发瘤中大部分为皮质和髓质肿瘤，因此需在术前做内分泌检查，确定有无功能；对直径大于3cm的无功能肿瘤及有功能或疑有恶变的需手术治疗；而小于3cm无功能肿瘤可定期随访。     

肾上腺偶发瘤的诊治分析

目的：提高肾上腺偶发瘤的诊断和治疗水平。方法：回顾性分析1998年1月～2006年7月收治的48例肾上腺偶发瘤患者的临床资料,并进行术后病理及随访结果分析。46例患者行手术治疗,其中开放手术15例,经腹腔镜治疗31例。结果：手术效果满意。术后病理检查诊断为肾上腺皮质腺瘤27例,肾上腺囊肿5例,肾上腺皮质癌2例,肾上腺髓性脂肪瘤3例,肾上腺嗜铬细胞瘤3例,原发性醛固酮瘤3例,腹膜后原发性淋巴瘤、皮质腺瘤伴灶状髓性脂肪瘤、转移癌各1例。影像学及实验室检查术前获正确诊断者32例（66．7％）。结论：所有肾上腺偶发瘤均应行内分泌功能检查。内分泌功能检查与CT或MRI联合应用对确诊肾上腺占位性病变有较高价值。对于确诊为恶性肿瘤、功能性肿瘤、转移性肿瘤及直径大于3cm的肿瘤,应积极采取手术治疗。腹腔镜手术创伤小,恢复快,为首选术式。对非功能性、直径小于3．0cm的肿瘤,可定期行生化和影像学检查。     

肾上腺偶发瘤的外科治疗选择

目的 探讨肾上腺偶发瘤的手术指征.方法 总结147例肾上腺偶发瘤患者资料,分析偶发瘤的手术指征,比较腹腔镜和开放性手术的适应证.147例患者中,恶性肿瘤19例(12.9%),平均直径(8.5±3.9)cm,≤4 cm者4例(21.1%),其中肾上腺皮质癌15例、恶性嗜铬细胞瘤4例;良性功能性肿瘤29例(19.7%),平均直径(4.1±2.1)cm,其中≥3 cm者22例(75.9%);19例良性嗜铬细胞瘤中24 h尿香草扁桃酸升高2例,5例醛固酮瘤中血钾稍低2例,5例亚临床库欣综合征腺瘤患者血皮质醇升高,均无明显内分泌异常症状;良性无功能性肿瘤99例(67.3%),其中肾上腺皮质腺瘤61例(61.6%).结果 147例均行手术治疗.腹腔镜下手术组102例,开放性手术组45例,2组肿瘤直径分别为(3.4±1.8)cm和(6.7±1.5)cm(P＜0,0001);手术并发症发生率分别为5.9%(6/102)和15.6%(7/45)(P=0.1103).腹腔镜中转开放手术5例(4.9%),主要见于黏连严重的恶性肿瘤或肿瘤直径＞6 cm者.结论 肾上腺偶发瘤常见类型为无功能肾上腺腺瘤、嗜铬细胞瘤、肾上腺皮质癌.可疑恶性、有内分泌功能、直径≥3 cm的肾上腺偶发瘤应积极手术治疗.腹腔镜手术创伤小、恢复快,为手术首选;肿瘤直径＞6 cm、黏连严重、可疑恶性者应以开放性手术为主.     

肾上腺偶发瘤的手术治疗(附47例报告)

目的：探讨肾上腺偶发瘤的手术治疗方式。方法：采用开放手术治疗肾上腺偶发瘤４４例，经腹腔镜手术治疗３例。结果：所有病例均完整切除肿瘤，肿瘤最大直径１．２￣１７．０ｃｍ，疗效满意。结论：对肾上腺偶发瘤，术前应常规行内分泌检查；对肿瘤直径〈６ｃｍ而影像学检查无粘连者，可作腹腔镜探查；对肿瘤直径〉６ｃｍ或术前怀疑为嗜铬细胞瘤者，或肿瘤与周围脏器有粘连者，以行开放手术为宜。     

肾上腺髓性脂肪瘤15例报告

目的：提高对肾上腺髓性脂肪瘤的认识。方法：回顾性分析15例肾上腺髓性脂肪瘤患者的临床资料并复习相关文献。结果：15例中，10例为偶发瘤，2例出现血儿茶酚胺浓度升高；术前均行CT或MRI检查，除1例未能明确诊断外，其余均确诊为肾上腺髓性脂肪瘤，术后均经病理检查证实为肾上腺髓性脂肪瘤。结论：肾上腺髓性脂肪瘤无特异性临床表现，绝大部分患者仅靠CT或MRI的特异性影像即能被明确诊断。对直径＜2．5cm的偶发瘤可随访观察，对直径＞5cm的肿瘤均应手术切除，术前宜行内分泌功能检测。     

1006例肾上腺肿瘤诊治体会

目的　提高肾上腺肿瘤的诊断和治疗水平。　方法　总结 10 0 6例肾上腺肿瘤的诊治经验。　结果　 10 0 6例中有功能肿瘤 845例 ( 84.0 % ) ,其中恶性肿瘤 12例 ( 1.4% ) ;无功能肿瘤 161例 ( 16% ) ,其中恶性肿瘤 11例 ( 6.8% ) ;180例肾上腺偶发瘤中发现嗜铬细胞瘤 19例。本组例行肿瘤切除 996例 ,手术探查 10例 ,手术死亡率为 0 .3 %。　结论　肾上腺肿瘤好发年龄为 3 0～ 5 0岁 ,库兴综合征女性明显多于男性。对肾上腺肿瘤应行内分泌检测 ,定位方法首选B超和CT。功能性肿瘤和体积大的无功能肿瘤应行手术治疗 ,<3cm无功能肾上腺肿瘤可以长期随访     

肾上腺偶发瘤

本文报告了自１９９０－１９９５年收治经ＣＴ，Ｂ超检查发现的１０例肾上腺偶发瘤。其中肾上腺皮质腺瘤４例，肾上腺髓性脂肪瘤３例，肾上腺囊肿２例，肾上腺转移癌１例。全组有３例存在内分泌功能。肾上腺偶发瘤大部分是良性非功能性肿瘤。但也在相当部分为恶发表中具有内分泌功能。     

无功能性肾上腺肿瘤的诊断与治疗(附39例报告)

目的：提高无功能性肾上腺肿瘤的诊治水平。方法：回顾性分析我院17年来39例无功能性肾上腺肿瘤患者的临床资料。结果：39例中,38例行肿瘤切除或剜除术,1例仅行活组织检查;30例病理检查证实为良性无功能性肾上腺肿瘤,其中节细胞神经瘤7例,平滑肌瘤1例,皮质腺瘤10例,髓脂瘤3例,神经鞘瘤1例．肾上腺囊肿8例。随访6个月～7年,临床症状消失,无肿瘤复发。9例病理检查证实为恶性无功能性肾上腺肿瘤,其中脂肪肉瘤1例,皮质腺癌4例,转移癌4例,术后2年内,8例死亡,1例无癌生存14个月。结论：无功能性肾上腺肿瘤临床少见,早期诊断困难,CT是首选检查方法,确诊依赖于病理检查。手术切除是良性肿瘤的有效手段,但对恶性肿瘤预后较差。     

肾上腺偶发瘤52例临床分析

目的 提高肾上腺偶发瘤早期诊断与鉴别诊断水平，指导临床治疗。方法 本组52例均为健康体检发现的肾上腺偶发瘤。男35例，女17例，年龄23～65岁，平均42岁。均无高血压及内分泌紊乱的临床症状和体征。肿瘤直径≥3．0cm者33例。52例均行血生化、电解质检查，肾上腺皮、髓质代谢的生化检测及腹部超声、CT检查；6例行MRI检查，2例行PET检查，1例行肾上腺I—MIBG核素扫描。52例均行手术治疗。结果 肾上腺偶发瘤52例经病理证实皮质腺瘤27例，转移瘤7例，嗜铬细胞瘤5例，囊肿4例，原发性醛固酮瘤3例，神经鞘瘤2例，皮质癌1例，腹膜后神经母细胞瘤1例，腹膜后原发性淋巴瘤1例，神经节纤维瘤1例。影像学及实验室检查术前获正确诊断者14例(27％)。10例恶性肿瘤者中，5例肾上腺转移瘤者术后行化疗，6—10个月内死亡，余5例失访。42例良性病变者随访6个月～9年，未见肿瘤复发。结论 肾上腺偶发瘤术前定性诊断困难，应积极手术治疗。     

肾上腺偶发瘤临床分析

目的 总结肾上腺偶发瘤的临床、内分泌及病理学特点. 方法回顾性分析97例病理确诊肾上腺偶发瘤患者的临床资料.男53例,女44例.平均年龄45岁.肿瘤位于左侧38例、右侧52例、双侧7例.有较完整内分泌检测资料者74例.肿瘤最大直径由B超确定8例、CT确定54例、MRI确定35例. 结果 97例中恶性肿瘤20例(20.6%),其中肾卜腺皮质癌12例、恶性嗜铬细胞瘤3例、转移癌2例,肉瘤、神经母细胞瘤、恶性神经鞘瘤各1例;肾上腺皮质腺瘤26例(26.8%),良性嗜铬细胞瘤21例(21.6%),髓脂肪瘤9例(9.3%),肾上腺囊肿13例(13.4%),节细胞神经瘤5例(5.2%),神经纤维瘤3例(3.1%).高血压病患者40例(41.2%),功能性偶发瘤21例(28.4%).肿瘤直径<4 cm者25例(25.8%)、4～6 cm者33例(34.0%)、>6 era者39例(40.2%).肿瘤直径<4 cm者中恶性肿瘤仅1例(4%).恶性肿瘤直径(9.9±4.6)cm,良性肿瘤直径(5.6±3.2)锄(P=0.01).恶性肿瘤中直径>6 cm者15例(75.0%),良性肿瘤中27例(35.1%,P=0.001).恶性肿瘤患者体质量减轻者5例(25.0%),良性肿瘤者中2例(2.6%,P==0.004). 结论 肾上腺偶发瘤中皮质腺瘤、良性嗜铬细胞瘤和恶性肿瘤居前3他,偶发瘤均应进行详细的内分泌检测,肿瘤直径<4 cm足筛选无内分泌异常的偶发瘤随访时的一项重要指标.     

Diagnosis and management of adrenal incidentalomas

PURPOSE: The incidental discovery of adrenal masses has become a common clinical problem. We address current trends in clinical, endocrine, radiological and scintigraphic evaluation, and strategies for management of adrenal masses. A diagnostic and therapeutic algorithm is suggested. MATERIALS AND METHODS: A comprehensive review of the literature was performed using MEDLINE, bibliographies of select articles, current issues of peer reviewed general medicine, endocrinology, diagnostic imaging and surgical journals, and meeting abstracts of recent international congresses. RESULTS: Most adrenal incidentalomas are benign and nonhypersecreting but all should be evaluated to exclude from diagnosis hypersecretory syndromes or malignancy. In all cases hormonal screening for pheochromocytoma, hyperaldosteronism and subclinical hypercortisolism should be performed. Attenuation values on computerized tomography, chemical shift magnetic resonance imaging and scintigraphy reveal the nature of the mass in most cases. Fine needle aspiration biopsy should be reserved for cases suspected of extra-adrenal malignancy. CONCLUSIONS: A multidisciplinary approach, including hormonal screening, radiological evaluation and scintigraphy, is required to identify and remove adrenal masses with endocrine and oncological morbidity. Long-term morphofunctional followup is suggested for nonoperated cases.     

肾上腺偶发瘤128例临床分析

目的 提高肾上腺偶发瘤的早期诊断与鉴别诊断水平,指导临床治疗.方法 回顾性分析1996年3月至2010年3月在我院健康体检或因肾上腺以外疾病就诊而发现的128例肾上腺偶发瘤患者的资料.男60例,女68例.年龄20～75岁,平均50岁.肿瘤直径＜3 cm者63例,3～6cm者56例,＞6 cm者10例.128例患者均行血生化、电解质和肾上腺皮、髓质代谢检测及腹部超声、CT检查;6例行MRI检查.128例均行手术治疗.结果 128例术后病理诊断肾上腺皮质腺瘤85例,嗜铬细胞瘤13例,肾上腺囊肿8例,神经节瘤、髓样脂肪瘤各7例,肾上腺皮质结节状增生4例,肾上腺皮质癌2例,肾上腺皮质嗜酸细胞瘤、神经鞘瘤、肾上腺脂肪肉瘤各1例.其中1例嗜铬细胞瘤患者术中死于低血压休克,未计入总例数.结论 肾上腺偶发瘤术前定性诊断困难,对于直径＞6 cm及功能性偶发瘤应积极手术治疗.

Abstract：

Objective To improve the early diagnosis and differential diagnosis of adrenal incidentalomas to guide clinical management of this disease. Methods One hundred and twenty-eight cases were diagnosed as adrenal incidentalomas due to health examination or treatment of other than adrenal disease,including 60 males and 68 females,whose ages were between 20 and 75 years,with a mean age of 50 years.Tumor diamer:＜3 cm 63 cases,3-6 cm 6 cases,＞6 cm 10 cases.128 patients all had biochemical and electrolyte examination,adrenal cortex and medulla biochemical testing,abdominal ultrasound and CT examination,6 cases with MRI examination.Surgery and post operative pathological examination were performed in all patients. Results Post operative pathology finally diagnosed adrenocortical adenoma in 85 cases,pheochromocytoma in 13 cases,adrenal cyst in 8 cases,paraganglioma and myeiolipoma in 7 eases respectively,adrenal nodular hyperplasia in 4 cases,adrenocortical carcinoma in 2 cases,adrenoconical oncocytoma,cellular Schwannoma and adrenal liposarcoma in 1 case,respectively.One case of pheochromocytoma patients died of intraoperative hypotension,which is not included in the total number. Conclusions The preperative diagnosis of adrenal incidentalomas is difficult.For adrenal incidentalomas with diameter more than 6 cm and those with endocrine function,early surgicM treatment is recommended.     

Adrenal Incidentalomas: Experience in a Developing Country

BACKGROUND: The incidence of adrenal incidentalomas is rising worldwide. There is a concern about malignancy in large incidentalomas. There are few published articles from developing countries on this entity. The aim of this study was to analyze the clinical presentation, functional status, and final diagnosis of adrenal incidentalomas and, in particular, to look into the incidence of adrenal cortical carcinoma (ACC) in large adrenal incidentalomas managed at a tertiary referral hospital in northern India. METHODS: This is a retrospective study (January 1991-December 2005) of 59 patients with adrenal incidentaloma managed at our department. The mean tumor diameter was 7.8 +/- 4.0 cm. In all cases, clinical details, radiology findings, laboratory findings, intervention details, histology findings, and follow-up data were noted. Six patients in which the mass was ultimately found to arise from extra-adrenal tissue were excluded from final analysis RESULTS: Mean age of the patients was 46 +/- 12 years (M:F = 1:1.1). The incidentaloma measured more than 3 cm in 91% of cases and more than 6 cm in 70% of cases. The clinical scenarios leading to detection of incidentaloma included abdominal (56.6%), genitourinary (24.5%), and systemic complaints (15.1%) and routine medical checkup (3.7%). Most of cases were found by ultrasonography (n = 41), and remaining by CT scan (n = 10), and MRI (n = 2). The incidence of functioning tumors was 41.5% (hypercatecholinism 37.7 % and hypercortisolism 1.9%). Forty-nine patients were operated on. The important final pathology included ACC (7.5%), pheochromocytoma (PCC) (43%), adrenal cysts (13.2%), myelolipoma (11.3%), and inflammatory lesions (9.4%). CONCLUSION: In our experience, the incidence of PCC was high among large adrenal incidentalomas while that of ACC was lower than expected. Inflammatory lesions contribute to a significant number of cases of incidentaloma in developing countries. Adrenalectomy is a justified procedure for large incidentalomas, although the concern may not always be an underlying malignancy.     

Diagnostic and therapeutic strategy for an incidental finding of an adrenal mass

The incidental finding of an unsuspected adrenal mass ranges from 0.5% to 5% in abdominal CT series. The optimal diagnostic approach to such masses is to diagnose malignant or secretory tumors requiring excision and to otherwise avoid unnecessary surgery. Physical examination generally contributes little. A standard biochemical evaluation should include the measurement of 24 hour urinary catecholamines and metanephrine, urinary free cortisol and plasma cortisol levels at 8 a.m. and 8 p.m. combined with an overnight low-dose dexamethasone suppression test, serum potassium assay, and determination of upright plasma aldosterone to plasma renin activity. These tests will serve to screen for pheochromocytoma, subclinical Cushing's syndrome, and primary hyperaldosteronism respectively. Imaging characteristics suggestive of malignancy include: size greater than 4 cm., heterogeneous lesion and/or density greater than 20 Hounsfield Units on CT scan, slow enhancement with delayed washout after intravenous contrast injection on CT scan, and slightly decreased signal intensity in out of phase (fat suppressed) MR acquisition. Fine-needle aspiration biopsy should be performed only if metastatic disease is suspected. Adrenal scintigraphy with iodocholesterol may be useful where adenoma with subclinical Cushing's syndrome or solid tumor is suspected. In summary, the following strategy is recommended for the management of adrenal incidentalomas : mass lesions larger than 4 cm. and hormone-secreting tumors should be removed. All non-secreting adrenal incidentalomas smaller than 4 cm. in diameter should be followed by serial imaging at regular intervals (6, 12, and 36 months) and by endocrine reevaluation at one year.     

Adenomatoider Tumor der Nebenniere

Adenomatoid tumors are uncommon, benign tumors of the genital tract which have also been reported to occur extragenitally. Case reports on adenomatoid tumors of the adrenal gland exist. Most of these are incidentally discovered at autopsy or after the resection of incidentalomas. We report on the case of a young man with epigastic pain and with the finding of a 4 cm heterogeneous right adrenal mass on abdominal CT scan. After endocrine activity had been ruled out, an inactive, benign adrenal tumor was suspected and laparoscopic right adrenalectomy performed. The specimen was found to be an adenomatoid tumor. We discuss the differential diagnosis and the possible embryological origin of these tumors. The feature of 'local invasive ability' does not imply malignancy. All cases discovered surgically and at autopsy have been benign. Local resection seems to be the appropriate therapy.     

Preclinical Cushing''s syndrome: Report of seven cases and a review of the literature

BACKGROUND: Adrenal adenomas showing autonomous cortisol secretion without specific endocrine symptoms are sometimes discovered in patients with adrenal incidentalomas. This entity has been described as subclinical or preclinical Cushing's syndrome (PCS), but the endocrine data of reported cases have varied and the diagnostic criteria of PCS have been uncertain. METHODS: We report seven Japanese cases of PCS due to a unilateral, solitary adrenal adenoma with examination of the endocrine data of these patients. The diagnostic parameters of subtle hypercortisolism and the risk of postoperative adrenal insufficiency and surgical indications are discussed and reviewed. RESULTS: In the present cases, the most frequently found biochemical parameters of autonomous cortisol secretion were a low adrenocorticotropic hormone (ACTH) level (100%) and insufficient suppression of cortisol by low-dose dexamethasone (85.7%). Unilateral accumulation of radiopharmaceuticals in tumors was also frequently observed (100%). A postoperative hydrocortisone supplement was given to six of the seven patients for 5-122 days. It was not given to case 4, because a moderate response of 11-deoxycortisol to metyrapone was identified. Plasma ACTH levels and the diurnal rhythm of plasma cortisol rapidly recovered within 3 weeks postoperatively in six of the seven cases. CONCLUSION: This entity is heterogeneous and various degrees of cortisol excess have been observed. It should be diagnosed in the wide spectrum and the risk of adrenal insufficiency after surgery should be evaluated by dynamic tests such as the corticotropin-releasing hormone (CRH) test. Based on the results of the present study and a review of the literature, PCS patients may not require hydrocortisone supplement therapy for a long period.     

肾上腺偶发瘤27例

目的 提高对肾上腺偶发瘤的诊治水平。方法 对27例肾上腺偶发瘤的临床资料进行分析。结果 27例中,B超诊断21例,占77.8％,CT及MRI检查发现6例。27例均行手术治疗,效果满意。结论 在健康查体时应常规作肾上腺B超,对肾上腺偶发瘤直径>2.0cm者应手术治疗,而直径<0.2cm者可定期随访。