Al-Waeli Dheyaa Kadhim, Mansour Abbas Ali, Haddad Nazar S
Department of Medicine, College of Medicine, University of Thi-Qar, Nasiriyah, Dhi Qar, Iraq.
Department of Medicine, College of Medicine, University of Basrah, Basrah, Iraq.
Niger Postgrad Med J. 2020 Apr-Jun;27(2):101-107. doi: 10.4103/npmj.npmj_156_19.
Adrenal incidentaloma (AI) is an adrenal mass discovered accidentally during abdominal or chest imaging techniques not aimed to adrenal gland assessment. Guidelines suggested confirming the benignity of AI radiologically and excluding hormonal dysfunctions. This study evaluated the reliability of computed tomography (CT) scan radiological parameters in predicting the functionality of AI.
A cross-sectional study performed in Faiha Specialized Diabetes, Endocrine and Metabolism Centre from July 2017 to July 2018, involving 38 patients (23 females [60.5%]) harbouring 43 AI referred for evaluation. For all patients, we assessed history, physical examination, radiological parameters of AI by CT scan (native Hounsfield unit [HU]), maximum diameter and absolute percentage washout [APW] and blood investigations (glycated haemoglobin, adrenocorticotropic hormone, aldosterone, renin, aldosterone/renin ratio, normetanephrine, metanephrine, dehydroepiandrosterone sulphate, cortisol and 1 mg overnight dexamethasone suppression test).
Native CT adrenal HU ≥18.5 was statistically significant seen in most functional AI (FAI) (P = 0.006), especially in patients with mild autonomous cortisol excess (MACE) and pheochromocytoma (PCC) with P = 0.02 in both. Maximum diameter was significantly high (≥40 mm) in PCC and congenital adrenal hyperplasia (CAH) (P = 0.018 and 0.008, respectively). APW was significantly < 60% only in PCC (P = 0.02).
Native HU was the most significant radiological parameter in predicting the functionality of FAI, MACE and PCC, but not in CAH and aldosterone-producing adenoma. The maximum diameter was significant in predicting the PCC and CAH, whereas the APW was significant in predicting PCC only.
肾上腺偶发瘤（AI）是在并非针对肾上腺评估的腹部或胸部成像检查中偶然发现的肾上腺肿块。指南建议通过影像学检查确认AI的良性，并排除激素功能障碍。本研究评估了计算机断层扫描（CT）扫描的影像学参数在预测AI功能方面的可靠性。
2017年7月至2018年7月在法伊哈糖尿病、内分泌与代谢专科医院进行的一项横断面研究，纳入了38例患有43个AI的患者（23例女性[60.5%]），这些患者因AI前来评估。对所有患者，我们评估了病史、体格检查、通过CT扫描测定的AI影像学参数（平扫亨氏单位[HU]）、最大直径和绝对洗脱百分比[APW]以及血液检查（糖化血红蛋白、促肾上腺皮质激素、醛固酮、肾素、醛固酮/肾素比值、去甲肾上腺素、肾上腺素、硫酸脱氢表雄酮、皮质醇和1毫克过夜地塞米松抑制试验）。
在大多数功能性肾上腺偶发瘤（FAI）中，平扫CT肾上腺HU≥18.5具有统计学意义（P = 0.006），尤其是在轻度自主性皮质醇增多症（MACE）和嗜铬细胞瘤（PCC）患者中，两者的P值均为0.02。PCC和先天性肾上腺皮质增生症（CAH）的最大直径显著较大（≥40毫米）（分别为P = 0.018和0.008）。仅在PCC中，APW显著<60%（P = 0.02）。
平扫HU是预测FAI、MACE和PCC功能的最显著影像学参数，但对CAH和醛固酮瘤不适用。最大直径在预测PCC和CAH方面具有显著意义，而APW仅在预测PCC方面具有显著意义。
