Farrugia Frederick-Anthony, Misiakos Evangelos, Martikos Georgios, Tzanetis Panagiotis, Charalampopoulos Anestis, Zavras Nicolaos, Sotiropoulos Dimitrios, Koliakos Nikolaos
Private practice.
.
Rom J Intern Med. 2017 Dec 1;55(4):188-197. doi: 10.1515/rjim-2017-0025.
To present a step by step approach for the diagnosis of adrenal incidentaloma (AI).
An extensive review of the literature was conducted, searching the Pub-Med and Google Scholar using the Mesh terms; Adrenal; Incidentaloma; Adrenal tumours; Radiology; Diagnosis. We also did a cross-referencing search of the literature. Comments on the new European guidelines are presented.
The majority of the tumours are non-functioning benign adenomas. The most important radiological characteristic of an adrenal incidentaloma is the radiation attenuation coefficient. Wash out percentage and the imaging characteristics of the tumour may help in diagnosis.
Density less than 10 HU is in most cases characteristic of a lipid rich benign adenoma. More than 10 HU or/and history of malignancy raise the possibility for cancer. 1 mg dexamethasone test and plasma metanephrines should be done in all patients. If there is history of hypokalemia and/or resistant hypertension we test the plasma aldosterone to plasma renin ratio (ARR). Newer studies have shown that tumours even nonfunctioning and less than 4 cm may increase the metabolic risks so we may consider surgery at an earlier stage.
介绍肾上腺偶发瘤（AI）的逐步诊断方法。
对文献进行广泛综述，使用医学主题词（Mesh terms）在PubMed和谷歌学术上搜索；肾上腺；偶发瘤；肾上腺肿瘤；放射学；诊断。我们还对文献进行了交叉检索。并给出了对欧洲新指南的评论。
大多数肿瘤为无功能的良性腺瘤。肾上腺偶发瘤最重要的放射学特征是辐射衰减系数。洗脱百分比和肿瘤的影像学特征有助于诊断。
密度小于10 HU在大多数情况下是富含脂质的良性腺瘤的特征。大于10 HU或/和有恶性肿瘤病史增加了癌症的可能性。所有患者均应进行1毫克地塞米松试验和血浆甲氧基肾上腺素检测。如果有低钾血症和/或难治性高血压病史，则检测血浆醛固酮与血浆肾素比值（ARR）。最新研究表明，即使是无功能且小于4厘米的肿瘤也可能增加代谢风险，因此我们可能会考虑在更早阶段进行手术。
