Department of Surgery and Endocrinology, St George's Healthcare NHS Trust, Blackshaw Road, Tooting, London SW17 0QT, UK.
Int J Surg. 2012;10(9):555-9. doi: 10.1016/j.ijsu.2012.08.017. Epub 2012 Sep 5.
There are few published data on aldosterone and cortisol co-secreting adrenal tumours. Failure to perform comprehensive preoperative endocrine investigations in patients with adrenal "incidentalomas" or in those thought to be secreting only one hormone may account for this. Clinically patients with such lesions may have evidence of hypertension and hypokalaemia with no features of cortisol excess. Preoperative diagnosis of such lesions with accurate endocrinological work up is essential to prevent adrenal insufficiency and haemodynamic crises following removal of such glands. We present a series of 4 patients with co-secreting tumours treated by laparoscopic adrenalectomy between September 2010 and March 2011. Our experience suggests that dual secretors are more common than originally thought. A high index of suspicion and adequate endocrine work up is paramount in diagnosing such tumours and in experienced hands, laparoscopic adrenalectomy with appropriate substitutive steroid cover is safe, feasible and curative for these functioning adrenal tumours.
关于醛固酮和皮质醇共同分泌的肾上腺肿瘤，目前发表的数据很少。这可能是由于未能对肾上腺“偶发瘤”患者或仅被认为分泌一种激素的患者进行全面的术前内分泌检查所致。临床上，此类病变的患者可能有高血压和低钾血症的证据，但没有皮质醇过多的特征。通过准确的内分泌检查对这些病变进行术前诊断对于预防此类腺体切除后发生肾上腺功能不全和血流动力学危象至关重要。我们介绍了 4 例在 2010 年 9 月至 2011 年 3 月期间通过腹腔镜肾上腺切除术治疗的共同分泌肿瘤患者。我们的经验表明，双重分泌者比最初想象的更为常见。高度怀疑和充分的内分泌检查对于诊断此类肿瘤至关重要，并且在有经验的医生手中，腹腔镜肾上腺切除术加适当的类固醇替代治疗对于这些功能性肾上腺肿瘤是安全、可行和有效的。
