Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
Department of Endocrinology, Chinese People's Liberation Army General Hospital, Beijing, China.
Endocrine. 2022 Aug;77(2):372-379. doi: 10.1007/s12020-022-03077-w. Epub 2022 May 23.
To investigate the clinical characteristics, endocrinological function, and etiology of bilateral adrenal lesions in hospitalized patients.
A retrospective study of 777 patients with bilateral adrenal lesions was conducted at the Chinese People's Liberation Army General Hospital between January 2013 and January 2018. Patients' demographic features, hormonal profiles, imaging findings, and histopathological findings were reviewed from database records.
Of the 777 patients with bilateral adrenal lesions, 495 were men. The mean age at diagnosis was 52.0 ± 13.0 years. Overall, 511 (65.8%) cases were benign, followed by adrenal metastases (n = 224, 28.8%), pheochromocytoma (n = 26, 3.3%), adrenal lymphoma (n = 9, 1.2%), and adrenal corticocarcinoma (ACC; n = 7, 0.9%). Hormonal evaluation revealed that 34.3% of bilateral adrenal lesions were functional. The primary etiologies of functional lesions were primary aldosteronism (16.6%, 129/777), and primary bilateral macronodular adrenocortical hyperplasia (PBMAH; 8.8%, 68/777). Patients with lymphoma and metastases were significantly older than those with benign nonfunctional lesions (60.4 ± 11.0 years vs. 54.5 ± 10.4 years and 57.9 ± 10.8 years vs. 54.5 ± 10.4 years, respectively; both P < 0.001). Lesions in patients with adrenal lymphoma, ACC, pheochromocytoma, metastases, congenital adrenal hyperplasia, tuberculosis, and Cushing's syndrome were significantly larger than benign nonfunctional lesions (all P < 0.001).
Benign adrenal lesions and metastases from the lungs are the most common causes of bilateral adrenal lesions. Primary aldosteronism and PBMAH are the most prevalent functional lesions. Moreover, patients with lymphoma or metastases are older and their masses are larger.
探讨住院患者双侧肾上腺病变的临床特征、内分泌功能及病因。
对 2013 年 1 月至 2018 年 1 月期间在中国人民解放军总医院住院的 777 例双侧肾上腺病变患者进行回顾性研究。从数据库记录中查阅患者的人口统计学特征、激素谱、影像学表现和组织病理学表现。
777 例双侧肾上腺病变患者中，男性 495 例，诊断时的平均年龄为 52.0±13.0 岁。总体而言，良性病变 511 例（65.8%），其次为肾上腺转移瘤（224 例，28.8%）、嗜铬细胞瘤（26 例，3.3%）、肾上腺淋巴瘤（9 例，1.2%）和肾上腺皮质癌（7 例，0.9%）。激素评估显示，34.3%的双侧肾上腺病变为功能性。功能性病变的主要病因是原发性醛固酮增多症（16.6%，129/777）和双侧原发性大结节性肾上腺增生（8.8%，68/777）。与良性非功能性病变相比，患有淋巴瘤和转移瘤的患者年龄明显更大（分别为 60.4±11.0 岁、57.9±10.8 岁，和 54.5±10.4 岁、54.5±10.4 岁；均 P<0.001）。肾上腺淋巴瘤、肾上腺皮质癌、嗜铬细胞瘤、转移瘤、先天性肾上腺皮质增生症、结核和库欣综合征患者的病变明显大于良性非功能性病变（均 P<0.001）。
良性肾上腺病变和肺部转移瘤是双侧肾上腺病变最常见的原因。原发性醛固酮增多症和双侧原发性大结节性肾上腺增生是最常见的功能性病变。此外，患有淋巴瘤或转移瘤的患者年龄更大，其肿瘤更大。
