Moreno-Fernández Jesús, García-Manzanares Alvaro, Sánchez-Covisa Miguel Aguirre, García E Inés Rosa Gómez
Sección de Endocrinología y Nutrición, Complejo Hospitalario La Mancha Centro, Alcázar de San Juan, Ciudad Real, España.
Endocrinol Nutr. 2009 Dec;56(10):447-51. doi: 10.1016/S1575-0922(09)73312-1.
Incidentalomas are clinically silent adrenal masses that are discovered incidentally during diagnostic testing for clinical conditions unrelated to suspicion of adrenal disease. Several decision algorithms are used in the management of adrenal masses. We evaluated the routine use of these algorithms through a clinical activity questionnaire.
The questionnaire included data on the work center, initial hormonal and radiological study, imaging and hormonal tests performed to complete the study, surgical indications and clinical follow-up.
Thirty-three endocrinologists (79%) attending the annual congress of the Castilla-La Mancha Society of Endocrinology, Nutrition and Diabetes completed the questionnaire. Forty-six percent considered tumoral size to be the most important factor suggesting malignancy in the initial evaluation of adrenal incidentalomas, the limit being 4 cm for 78% of the endocrinologists. Imaging study was completed by magnetic resonance imaging by 39%. All the physicians always performed screening for hypercortisolism and pheochromocytoma. Other assessments always conducted in all incidentalomas included hyperaldosteronism (76%), sex hormone-producing tumor (51%) and congenital adrenal hyperplasia (30%). Seventy-nine percent of respondents began to refer incidentalomas larger than 4 cm for surgical treatment, and 46% referred all tumors larger than 6 cm for surgical treatment. With regard to hormonal function, patients with pheochromocytoma, Cushing's syndrome, hyperaldosteronism with poorly controlled blood pressure or sex hormoneproducing tumors were more frequently referred for surgery. Seventy-six percent of endocrinologists performed clinical follow-up in adrenal incidentalomas larger than 4 cm, preferably through computerized tomography (81%), and repeated studies for hormonal hypercortisolism (97%), primary hyperaldosteronism (42%) and pheochromocytoma (76%) over a 4-5 year period (67%).
Clinical practice varied among the endocrinologists surveyed, although a certain uniformity in relation to the main guidelines was observed. A tendency to request a greater number of diagnostic tests for initial hormone assessment and clinical follow-up was detected. Assessment, decision-making and medical monitoring in adrenal incidentalomas remain unclear and consequently further studies are required.
偶发瘤是临床上无症状的肾上腺肿块，在针对与肾上腺疾病怀疑无关的临床病症进行诊断检查时偶然发现。在肾上腺肿块的管理中使用了几种决策算法。我们通过临床活动问卷评估了这些算法的常规使用情况。
问卷包括工作中心、初始激素和放射学研究、为完成研究而进行的影像学和激素检测、手术指征及临床随访等数据。
参加卡斯蒂利亚 - 拉曼恰内分泌学、营养与糖尿病学会年度大会的33位内分泌学家（79%）完成了问卷。46%的人认为肿瘤大小是肾上腺偶发瘤初始评估中提示恶性的最重要因素，78%的内分泌学家认为界限为4厘米。39%的人通过磁共振成像完成影像学研究。所有医生均常规进行皮质醇增多症和嗜铬细胞瘤筛查。在所有偶发瘤中始终进行的其他评估包括醛固酮增多症（76%）、性激素分泌肿瘤（51%）和先天性肾上腺皮质增生症（30%）。79%的受访者开始将直径大于4厘米的偶发瘤转诊进行手术治疗，46%的人将所有直径大于6厘米的肿瘤转诊进行手术治疗。在激素功能方面，患有嗜铬细胞瘤、库欣综合征、血压控制不佳的醛固酮增多症或性激素分泌肿瘤的患者更常被转诊进行手术。76%的内分泌学家对直径大于4厘米的肾上腺偶发瘤进行临床随访，最好通过计算机断层扫描（81%），并在4至5年期间（67%）对激素皮质醇增多症（97%）、原发性醛固酮增多症（42%）和嗜铬细胞瘤（76%）进行重复检查。
在所调查的内分泌学家中临床实践存在差异，尽管在主要指南方面观察到一定的一致性。检测到在初始激素评估和临床随访中要求进行更多诊断测试的趋势。肾上腺偶发瘤的评估、决策和医学监测仍不明确，因此需要进一步研究。
