Endocrinology Unit, Department of Medicine DIMED, University of Padova, Via Ospedale Civile, 105-35128, Padova, Italy.
Endocrine Disease Unit, University-Hospital of Padova, Padova, Italy.
J Endocrinol Invest. 2021 Dec;44(12):2749-2763. doi: 10.1007/s40618-021-01615-3. Epub 2021 Jun 23.
Adrenal incidentalomas (AIs) are incidentally discovered adrenal masses, during an imaging study undertaken for other reasons than the suspicion of adrenal disease. Their management is not a minor concern for patients and health-care related costs, since their increasing prevalence in the aging population. The exclusion of malignancy is the first question to attempt, then a careful evaluation of adrenal hormones is suggested. Surgery should be considered in case of overt secretion (primary aldosteronism, adrenal Cushing's Syndrome or pheochromocytoma), however the management of subclinical secretion is still a matter of debate.
The aim of the present narrative review is to offer a practical guidance regarding the management of AI, by providing evidence-based answers to frequently asked questions.
The clinical experience is of utmost importance: a personalized diagnostic-therapeutic approach, based upon multidisciplinary discussion, is suggested.
偶然发现的肾上腺肿块(AIs),即在进行影像学检查时意外发现,而非出于怀疑肾上腺疾病的原因。随着人口老龄化,其发病率不断上升,因此,患者及其医疗保健相关费用都十分关注此类疾病的管理问题。首先需要排除恶性肿瘤,然后建议仔细评估肾上腺激素。如果存在明显的激素分泌(原发性醛固酮增多症、肾上腺库欣综合征或嗜铬细胞瘤),则应考虑手术治疗,但亚临床分泌的处理仍存在争议。
本综述的目的是通过提供常见问题的循证解答,为 AI 的管理提供实用指导。
临床经验至关重要:建议基于多学科讨论,采用个体化的诊断-治疗方法。