Division of Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy.
Endocrinol Metab (Seoul). 2020 Mar;35(1):26-35. doi: 10.3803/EnM.2020.35.1.26.
Adrenal masses are mainly detected unexpectedly by an imaging study performed for reasons unrelated to any suspect of adrenal diseases. Such masses are commonly defined as "adrenal incidentalomas" and represent a public health challenge because they are increasingly recognized in current medical practice. Management of adrenal incidentalomas is currently matter of debate. Although there is consensus on the need of a multidisciplinary expert team evaluation and surgical approach in patients with significant hormonal excess and/or radiological findings suspicious of malignancy demonstrated at the diagnosis or during follow-up, the inconsistency between official guidelines and the consequent diffuse uncertainty on management of small adrenal incidentalomas still represents a considerable problem in terms of clinical choices in real practice. The aim of the present work is to review the proposed strategies on how to manage patients with adrenal incidentalomas that are not candidates to immediate surgery. The recent European Society of Endocrinology/European Network for the Study of Adrenal Tumors guidelines have supported the view to avoid surveillance in patients with clear benign adrenal lesions <4 cm and/or without any hormonal secretion; however, newer prospective studies are needed to confirm safety of this strategy, in particular in younger patients.
肾上腺肿块主要是在因与肾上腺疾病无关的原因进行影像学检查时意外发现的。此类肿块通常被定义为“肾上腺意外瘤”，由于在当前的医学实践中越来越多地被认识到，因此成为了一个公共卫生挑战。肾上腺意外瘤的治疗目前存在争议。尽管在需要多学科专家团队评估和手术治疗方面存在共识，即对于诊断时或随访期间存在明显激素过多和/或影像学检查怀疑恶性肿瘤的患者，但在官方指南之间存在不一致性，并且在处理小的肾上腺意外瘤方面存在广泛的不确定性，这仍然是临床实践中治疗选择方面的一个重要问题。本研究旨在回顾目前对于不适合立即手术的肾上腺意外瘤患者的处理策略。最近的欧洲内分泌学会/欧洲肾上腺肿瘤研究网络指南支持对直径<4cm 且无任何激素分泌的明确良性肾上腺病变的患者避免进行监测的观点；然而，需要进行新的前瞻性研究来证实该策略的安全性，特别是在年轻患者中。
