Barzon Luisa, Sonino Nicoletta, Fallo Francesco, Palu Giorgio, Boscaro Marco
Department of Histology, Microbiology, and Medical Biotechnologies, University of Padua, Via Gabelli 63, 35121 Padua, Italy.
Eur J Endocrinol. 2003 Oct;149(4):273-85. doi: 10.1530/eje.0.1490273.
Clinically silent adrenal masses discovered by imaging studies performed for unrelated reasons, i.e. adrenal incidentalomas, have become a rather common finding in clinical practice. However, only limited studies of incidence, prevalence, and natural history of adrenal incidentalomas are available. A comprehensive review of the literature shows the prevalence of adrenal incidentalomas to be 2.3% at autopsy and 0.5-2% at abdominal computed tomography scan. Most lesions are adrenocortical adenomas at histology, whereas the prevalence of adrenocortical carcinomas is relatively low. The risk of malignancy over time for masses defined as benign at diagnosis is estimated at about 1/1000, even though 5-25% of masses increase in size during follow-up. Hyperfunction develops in about 1.7% of cases and the risk is higher in patients with lesions larger than 3 cm. Cortisol hypersecretion is the most likely disorder that may ensue, and it remains subclinical in about two-thirds of cases. The lack of controlled studies precludes making specific management recommendations. Large perspective controlled studies to define the epidemiology, natural history, and possible associated morbidity of adrenal incidentalomas and their impact on the quality of life of patients are needed.
因其他无关原因进行影像学检查时发现的临床无症状肾上腺肿块，即肾上腺偶发瘤，在临床实践中已成为相当常见的发现。然而，关于肾上腺偶发瘤的发病率、患病率及自然史的研究有限。对文献的全面综述显示，肾上腺偶发瘤在尸检中的患病率为2.3%，在腹部计算机断层扫描中的患病率为0.5%-2%。组织学检查显示大多数病变为肾上腺皮质腺瘤，而肾上腺皮质癌的患病率相对较低。诊断时定义为良性的肿块随时间推移发生恶变的风险估计约为1/1000，尽管5%-25%的肿块在随访期间会增大。约1.7%的病例会出现功能亢进，且病变大于3 cm的患者风险更高。皮质醇分泌过多是最可能随之发生的病症，约三分之二的病例仍为亚临床状态。由于缺乏对照研究，无法提出具体的管理建议。需要开展大型前瞻性对照研究，以明确肾上腺偶发瘤的流行病学、自然史、可能相关的发病率及其对患者生活质量的影响。
