Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Korean J Intern Med. 2013 Sep;28(5):557-64. doi: 10.3904/kjim.2013.28.5.557. Epub 2013 Aug 14.
BACKGROUND/AIMS: We investigated the clinical characteristics and follow-up findings of subjects with adrenal incidentalomas in a single, tertiary-care hospital in South Korea.
The study consisted of a retrospective analysis of 282 adrenal incidentaloma patients who underwent radiographic and endocrinological evaluations at Samsung Medical Center in Seoul, South Korea, between January 2004 and July 2011.
Most (86.2%) of the subjects were found to have nonfunctioning tumors. Functioning tumors were seen in 39 patients (13.8%). Among them, 28 (9.9%) had subclinical Cushing syndrome (SCS), six (2.1%) had pheochromocytoma, and five (1.8%) had primary hyperaldosteronism. Malignant adrenal tumors were discovered in three cases: two (0.7%) were primary adrenal cancers, and one (0.4%) was a secondary metastasis from a lung cancer. Significant risk factors for functional tumors were female gender (odds ratio [OR], 3.386; 95% confidence interval [CI], 1.611 to 7.117; p = 0.0013) and a noncontrast attenuation value of > 10 Hounsfield units (OR, 2.806; 95% CI, 1.231 to 6.397; p = 0.0141). During follow-up (mean, 22.5 months) of 72 of the patients, three (4.2%) developed hormonal changes due to functional tumors. One was confirmed as pheochromocytoma by histopathology, and the others were diagnosed with SCS and followed routinely without surgical intervention. No malignant transformation was found in these patients.
Based on these findings, initial hormonal and radiographic evaluations for adrenal incidentalomas appear to be more important than follow-up tests because functional or malignant changes are rare.
背景/目的：我们调查了在韩国一家单一的三级保健医院中肾上腺意外瘤患者的临床特征和随访结果。
本研究包括对 282 例肾上腺意外瘤患者的回顾性分析，这些患者于 2004 年 1 月至 2011 年 7 月在韩国首尔三星医疗中心接受了影像学和内分泌学评估。
大多数（86.2%）患者的肿瘤为无功能。有功能的肿瘤见于 39 例（13.8%）患者。其中，28 例（9.9%）为亚临床库欣综合征（SCS），6 例（2.1%）为嗜铬细胞瘤，5 例（1.8%）为原发性醛固酮增多症。发现 3 例恶性肾上腺肿瘤：2 例（0.7%）为原发性肾上腺癌，1 例（0.4%）为肺癌继发转移。功能性肿瘤的显著危险因素为女性（比值比[OR]，3.386；95%置信区间[CI]，1.611 至 7.117；p = 0.0013）和非增强 CT 值> 10 亨氏单位（OR，2.806；95% CI，1.231 至 6.397；p = 0.0141）。对 72 例患者进行了 22.5 个月的随访，其中 3 例（4.2%）因功能性肿瘤发生激素变化。1 例经组织病理学证实为嗜铬细胞瘤，其余 2 例诊断为 SCS，无需手术干预，常规随访。这些患者均未发现恶性转化。
根据这些发现，对肾上腺意外瘤进行初始的激素和影像学评估似乎比随访检查更重要，因为功能性或恶性变化较为罕见。
