2nd Department of Internal Medicine, Attikon University Hospital, Athens, Greece.
Nat Rev Endocrinol. 2011 Jun 28;7(11):668-80. doi: 10.1038/nrendo.2011.92.
Endocrine glands are among the organs that most frequently harbor incidentally discovered lesions. Pituitary, thyroid, parathyroid and adrenal incidentalomas are increasingly encountered in everyday practice with variable clinical implications. The major concerns are the risks of malignancy and hormonal hypersecretion mostly in the form of subclinically functioning tumors. Pituitary incidentalomas are usually microadenomas and most of the time clinically unimportant; however, incidentally discovered larger lesions require a more careful diagnostic and therapeutic approach. Thyroid incidentalomas are extremely common; exclusion of malignancy is the main concern in this clinical setting. Although parathyroid adenomas are not uncommon, these lesions are frequently missed owing to their small size and due to clinical unawareness. Adrenal incidentalomas carry a small but finite risk of malignancy. An intriguing challenge regarding incidentally discovered adrenal lesions is that a substantial proportion is associated with hormonal alterations, mainly in the form of subtle cortisol excess. Although still largely controversial, evidence is emerging that so-called subclinical hypercortisolism may not be completely harmless. The best biochemical criterion of subtle cortisol excess remains elusive. Surgical intervention in selected cases results in some beneficial effects, but more data are required in order to routinely support surgery in this clinical setting. This Review provides a brief overview of the prevalence, clinical effect and management of endocrine incidentalomas with a focus on data regarding the diagnostic and therapeutic challenges imposed by incidentally discovered adrenal lesions.
内分泌腺是最常偶然发现病变的器官之一。在日常实践中，垂体、甲状腺、甲状旁腺和肾上腺偶发瘤的发病率越来越高，其临床意义也各不相同。主要关注点是恶性肿瘤和激素过度分泌的风险，主要以亚临床功能肿瘤的形式存在。垂体偶发瘤通常为微腺瘤，大多数情况下临床意义不大；然而，偶然发现的较大病变需要更仔细的诊断和治疗方法。甲状腺偶发瘤非常常见；在这种临床情况下，主要关注的是排除恶性肿瘤。尽管甲状旁腺腺瘤并不罕见，但由于其体积小且临床意识不足，这些病变经常被遗漏。肾上腺偶发瘤存在很小但有限的恶性肿瘤风险。偶然发现的肾上腺病变一个有趣的挑战是，相当一部分与激素改变有关，主要以微妙的皮质醇过多的形式存在。尽管仍存在很大争议，但有证据表明，所谓的亚临床皮质醇增多症可能并非完全无害。微妙皮质醇过多的最佳生化标准仍难以捉摸。在某些情况下，手术干预会产生一些有益的效果，但为了在这种临床情况下常规支持手术，还需要更多的数据。本综述简要概述了内分泌偶发瘤的患病率、临床影响和治疗方法，重点介绍了关于偶然发现的肾上腺病变所带来的诊断和治疗挑战的数据。
