Ramsetty Anita, Bragg Scott, Bradford Sarah, Bain Jennifer
Department of Family Medicine MUSC, 5 Charleston Center Drive, Charleston, SC 29425.
Trident Family Health Department of Family Medicine MUSC, 9228 Medical Plaza Dr, Charleston, SC 29406.
FP Essent. 2018 Nov;474:28-32.
Incidentally discovered adrenal masses, referred to as adrenal incidentalomas, are fairly common given the routine use of imaging as part of clinical care in a variety of settings. Adrenal incidentalomas most frequently are benign and hormonally inactive tumors. However, approximately 11% to 15% are hormonally active, which can lead to diagnosis of clinically relevant conditions that affect morbidity and mortality. Thus, all adrenal incidentalomas should be tested for production of hormones at initial diagnosis. A 1-mg dexamethasone suppression test is the initial screening test. Patients then should be referred for appropriate treatment. Among the adrenal mass subtypes, pheochromocytomas are associated with the highest risk of mortality. Every effort should be made to exclude the presence of these tumors. Patients with hypertension and adrenal incidentalomas should be evaluated for aldosterone excess with an aldosterone to renin ratio. Primary malignancy represents a low percentage of adrenal incidentalomas. A minority of adrenal malignancies are primary adrenocortical tumors, which are associated with a poor prognosis and for which management often is palliative.
偶然发现的肾上腺肿块，即肾上腺偶发瘤，鉴于在各种临床环境中常规使用影像学作为临床护理的一部分，这种情况相当常见。肾上腺偶发瘤最常见的是良性且无激素活性的肿瘤。然而，约11%至15%是有激素活性的，这可能导致诊断出影响发病率和死亡率的临床相关病症。因此，所有肾上腺偶发瘤在初次诊断时都应检测激素分泌情况。1毫克地塞米松抑制试验是初始筛查试验。然后应将患者转诊进行适当治疗。在肾上腺肿块亚型中，嗜铬细胞瘤与最高的死亡风险相关。应尽一切努力排除这些肿瘤的存在。患有高血压和肾上腺偶发瘤的患者应通过醛固酮与肾素比值评估是否存在醛固酮过多。原发性恶性肿瘤在肾上腺偶发瘤中所占比例较低。少数肾上腺恶性肿瘤是原发性肾上腺皮质肿瘤，其预后较差，治疗通常是姑息性的。
