Institute of Urology, University of Southern California, Los Angeles, California.
Division of Endocrinology and Diabetes, University of Southern California, Los Angeles, California.
J Urol. 2021 Jan;205(1):52-59. doi: 10.1097/JU.0000000000001342. Epub 2020 Aug 28.
Adrenal incidentalomas are being discovered with increasing frequency, and their discovery poses a challenge to clinicians. Despite the 2002 National Institutes of Health consensus statement, there are still discrepancies in the most recent guidelines from organizations representing endocrinology, endocrine surgery, urology and radiology. We review recent guidelines across the specialties involved in diagnosing and treating adrenal incidentalomas, and discuss points of agreement as well as controversy among guidelines.
PubMed®, Scopus®, Embase™ and Web of Science™ databases were searched systematically in November 2019 in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement to identify the most recently updated committee produced clinical guidelines in each of the 4 specialties. Five articles met the inclusion criteria.
There is little debate among the reviewed guidelines as to the initial evaluation of an adrenal incidentaloma. All patients with a newly discovered adrenal incidentaloma should receive an unenhanced computerized tomogram and hormone screen. The most significant points of divergence among the guidelines regard reimaging an initially benign appearing mass, repeat hormone testing and management of an adrenal incidentaloma that is not easily characterized as benign or malignant on computerized tomography. The guidelines range from actively recommending against any repeat imaging and hormone screening to recommending a repeat scan as early as in 3 to 6 months and annual hormonal screening for several years.
After reviewing the guidelines and the evidence used to support them we posit that best practices lie at their convergence and have presented our management recommendations on how to navigate the guidelines when they are discrepant.
随着人们越来越频繁地发现偶然发现的肾上腺肿瘤，这给临床医生带来了挑战。尽管 2002 年美国国立卫生研究院达成了共识声明，但内分泌学、内分泌外科、泌尿科和放射科代表的最新指南仍存在差异。我们回顾了参与诊断和治疗偶然发现的肾上腺肿瘤的专业指南，讨论了指南之间的共识和争议点。
根据 PRISMA（系统评价和荟萃分析的首选报告项目）声明，我们于 2019 年 11 月在 PubMed ® 、Scopus ® 、Embase ™ 和 Web of Science ™ 数据库中系统地搜索了与 4 个专业相关的最新委员会制定的临床指南。符合纳入标准的文章有 5 篇。
在审查的指南中，对于偶然发现的肾上腺肿瘤的初始评估几乎没有争议。所有新发现的偶然发现的肾上腺肿瘤患者都应接受增强计算机断层扫描和激素筛查。指南之间分歧最大的是重新评估最初表现为良性的肿块、重复激素检测以及对计算机断层扫描不易确定为良性或恶性的偶然发现的肾上腺肿瘤的管理。这些指南从积极建议不进行任何重复成像和激素筛查到建议在 3 至 6 个月内重复扫描，并在几年内每年进行激素筛查。
在审查了指南及其支持的证据后，我们认为最佳实践在于它们的融合，并提出了我们的管理建议，以指导如何在指南不一致时进行操作。
