Scaroni C, Selice R, Benedini S, De Menis E, Arosio M, Ronchi C, Gasperi M, Manetti L, Arnaldi G, Polenta B, Boscaro M, Albiger N, Martino E, Mantero F
Department of Medical and Surgical Sciences, Endocrinology Unit, University of Padua, 35128 Padua, Italy.
J Endocrinol Invest. 2008 Jul;31(7):602-6. doi: 10.1007/BF03345609.
Acromegaly is associated with a greater morbidity and higher incidence of tumors, possibly due to the permissive role of elevated GH and IGF-I levels. In the general population, adrenal masses are frequently discovered (prevalence 1-5%) at computed tomography (CT). We evaluated the prevalence of adrenal lesions in patients with acromegaly. We studied 94 acromegalic patients, 54 females (mean age 55.0+/-16.0 yr) and 40 males (mean age 50+/-14 yr) referred to 5 Endocrinology Units between 2001-2003; 49 had active disease and 45 had been treated with surgery and/or were controlled with medical therapy. Abdominal CT showed adrenal lesions in 27 patients; 9 of them had unilateral masses (10%) with benign features (diameter 0.5-3 cm) and 18 had hyperplasia (14 monolateral and 4 bilateral), with no significant differences between patients with active vs controlled disease, and with no correlation between prevalence of masses and duration of disease, GH and IGF-I levels. Hormone study (urinary free cortisol, catecholamines/metanephrines, upright plasma renin activity and aldosterone, morning plasma ACTH and low-dose dexamethasone suppression test) disclosed no major endocrine alterations. During a 1-yr follow-up, the adrenal masses increased in size in 3 cases and 1 patient also developed subclinical Cushing's syndrome. Adrenal lesions seem more frequent in acromegaly than in the general population, but no single factor (GH/IGF-I levels or disease duration) predicts them. The masses appear to be benign and nonhypersecreting, but a longer follow-up is recommended to disclose any changes in their morphofunctional state.
肢端肥大症与更高的发病率和肿瘤发生率相关，这可能归因于生长激素（GH）和胰岛素样生长因子-1（IGF-I）水平升高所起的促进作用。在普通人群中，肾上腺肿块在计算机断层扫描（CT）检查时经常被发现（患病率为1%-5%）。我们评估了肢端肥大症患者肾上腺病变的患病率。我们研究了2001年至2003年间转诊至5个内分泌科的94例肢端肥大症患者，其中54例为女性（平均年龄55.0±16.0岁），40例为男性（平均年龄50±14岁）；49例患有活动性疾病，45例接受过手术治疗和/或接受药物治疗且病情得到控制。腹部CT显示27例患者存在肾上腺病变；其中9例有单侧肿块（10%），具有良性特征（直径0.5-3厘米），18例有增生（14例单侧和4例双侧），活动性疾病患者与病情得到控制的患者之间无显著差异，肿块患病率与疾病持续时间、GH和IGF-I水平之间也无相关性。激素检查（尿游离皮质醇、儿茶酚胺/甲氧基肾上腺素、立位血浆肾素活性和醛固酮、晨血浆促肾上腺皮质激素和小剂量地塞米松抑制试验）未发现重大内分泌改变。在1年的随访期间，3例患者的肾上腺肿块大小增加，1例患者还出现了亚临床库欣综合征。肢端肥大症患者的肾上腺病变似乎比普通人群更常见，但没有单一因素（GH/IGF-I水平或疾病持续时间）可以预测这些病变。这些肿块似乎是良性的且无分泌亢进，但建议进行更长时间的随访以发现其形态功能状态的任何变化。
