Kastelan Darko
a School of Medicine, University of Zagreb, Zagreb, Croatia and Department of Endocrinology, University Hospital Zagreb, Zagreb, Croatia.
Expert Rev Endocrinol Metab. 2011 Nov;6(6):811-817. doi: 10.1586/eem.11.75.
The term adrenal incidentaloma covers a wide spectrum of adrenal pathologies sharing the method of discovery. The management of adrenal incidentaloma is controversial, and clinicians should determine whether the patient's health is affected by the presence of a tumor. Critical points in management include differentiating benign from malignant and hormonally active from nonfunctional adrenal masses. The probability of malignancy is related to tumor size and imaging phenotype. Masses smaller than 4 cm in diameter that exhibit low attenuation by unenhanced CT scan and rapid contrast washout by delayed contrast-enhanced CT scan are probably benign. All patients with adrenal incidentaloma should undergo biochemical evaluations for pheochromocytoma and subclinical or overt Cushing's syndrome, and hypertensive patients should undergo biochemical testing for hyperaldosteronism. Laparoscopic adrenalectomy is the treatment of choice in all hypersecretory tumors. If adrenocortical carcinoma is suspected, an open adrenalectomy is recommended. Patients who are not candidates for surgical resection of the tumor should be monitored radiographically for 2 years, and hormonal follow-up should be performed annually for 4 years.
肾上腺偶发瘤涵盖了一系列通过相同发现方式检出的肾上腺病变。肾上腺偶发瘤的处理存在争议，临床医生应确定肿瘤的存在是否影响患者健康。处理的关键点包括区分良性与恶性以及激素活性与无功能肾上腺肿块。恶性的可能性与肿瘤大小及影像学表现相关。直径小于4 cm、平扫CT呈低密度且延迟增强CT扫描对比剂快速廓清的肿块可能为良性。所有肾上腺偶发瘤患者均应接受针对嗜铬细胞瘤和亚临床或显性库欣综合征的生化评估，高血压患者应接受原发性醛固酮增多症的生化检测。腹腔镜肾上腺切除术是所有分泌过多肿瘤的首选治疗方法。如果怀疑肾上腺皮质癌，建议行开放性肾上腺切除术。不适合手术切除肿瘤的患者应进行2年的影像学监测，并每年进行4年的激素随访。
