Higgins J C, Fitzgerald J M
Naval Hospital, Jacksonville, Florida, USA.
Am Fam Physician. 2001 Jan 15;63(2):288-94, 299.
Incidental renal or adrenal masses are sometimes found during imaging for problems unrelated to the kidneys and adrenal glands. Knowledgeable family physicians can reliably diagnose these masses, thereby avoiding unnecessary worry and procedures for their patients. A practical and cost-efficient means of evaluating renal lesions combines ultrasonography and computed tomographic scanning, with close communication between the family physician and the radiologist. Asymptomatic patients with simple renal cysts require no further evaluation. Patients with minimally complicated renal cysts can be followed radiographically. Magnetic resonance imaging is indicated in patients with indeterminate renal masses, and referral is required in patients with symptoms or solid masses. The need for referral of patients with adrenal masses is determined by careful assessment of clinical signs and symptoms, as well as the results of screening laboratory studies and appropriate radiologic studies. Referral is indicated for patients with incidental adrenal masses more than 6 cm in greatest diameter. Appropriate laboratory screening tests include the following: a 24-hour urinary free cortisol measurement for patients with evidence of Cushing's syndrome; a 24-hour urinary metanephrine, vanillylmandelic acid or catecholamine measurement for patients with evidence of pheochromocytoma; and a serum potassium level for patients with evidence of hyperaldosteronism.
在针对与肾脏和肾上腺无关的问题进行影像学检查时，有时会偶然发现肾脏或肾上腺肿块。经验丰富的家庭医生能够可靠地诊断这些肿块，从而避免让患者产生不必要的担忧以及接受不必要的检查。一种实用且经济高效的评估肾脏病变的方法是将超声检查和计算机断层扫描相结合，并让家庭医生与放射科医生保持密切沟通。无症状的单纯性肾囊肿患者无需进一步评估。轻度复杂性肾囊肿患者可进行影像学随访。对于肾脏肿块性质不明的患者，需进行磁共振成像检查，有症状或发现实性肿块的患者则需要转诊。对于肾上腺肿块患者是否需要转诊，需通过仔细评估临床体征和症状以及筛查实验室检查结果和适当的影像学检查结果来确定。直径大于6 cm的偶然发现的肾上腺肿块患者需要转诊。适当的实验室筛查检查如下：对于有库欣综合征证据的患者，测量24小时尿游离皮质醇；对于有嗜铬细胞瘤证据的患者，测量24小时尿间甲肾上腺素、香草扁桃酸或儿茶酚胺；对于有醛固酮增多症证据的患者，测量血清钾水平。
