Department of Endocrine Surgery, University of California San Francisco, San Francisco, CA 94143, USA.
Surgery. 2010 Aug;148(2):392-7. doi: 10.1016/j.surg.2010.05.001. Epub 2010 Jun 23.
Adrenal incidentaloma remains a diagnostic challenge. Despite well-established management guidelines, the long-term results of following these guidelines are unknown. We sought to determine how accurately these guidelines identify functioning incidentalomas and how often these guidelines result in adrenalectomy for benign tumors.
We catalogued adrenal incidentalomas from a retrospective review of 500 consecutive adrenalectomies at a single institution. The outcome measures studied were patient demographics, preoperative biochemical analysis, imaging characteristics, tumor size, type of operation performed, and postoperative histologic diagnosis.
Eighty-one of the 500 adrenalectomies performed were for incidentalomas. Size was the only significant characteristic that distinguished cortical cancers from benign adenomas. Only 1 out of 26 functioning tumors was incorrectly identified on preoperative workup. We also found that 25% of cortisol-secreting incidentalomas were cystic, and that benign adenomas accounted for 42% of all tumors resected.
Current guidelines accurately predict the functional status of adrenal incidentalomas. Some cystic lesions may be functioning and should therefore be screened for hormonal hypersecretion. However, even with the most up-to-date diagnostic tools available, most adrenal incidentalomas resected are benign tumors.
肾上腺意外瘤仍然是一个诊断挑战。尽管有成熟的管理指南，但遵循这些指南的长期结果尚不清楚。我们试图确定这些指南在识别功能性意外瘤方面的准确性，以及这些指南导致良性肿瘤进行肾上腺切除术的频率。
我们对一家机构的 500 例连续肾上腺切除术进行了回顾性研究，对肾上腺意外瘤进行了编目。研究的结局指标包括患者人口统计学特征、术前生化分析、影像学特征、肿瘤大小、手术类型和术后组织学诊断。
500 例肾上腺切除术中有 81 例为意外瘤。大小是区分皮质癌和良性腺瘤的唯一显著特征。术前检查中只有 1 例功能性肿瘤被错误诊断。我们还发现，25%的皮质醇分泌性意外瘤是囊性的，良性腺瘤占切除的所有肿瘤的 42%。
目前的指南准确预测了肾上腺意外瘤的功能状态。一些囊性病变可能具有功能，因此应筛查激素过度分泌。然而，即使使用最先进的诊断工具，切除的大多数肾上腺意外瘤仍然是良性肿瘤。
