Shah Akash N, Saikia Uma K, Chaudhary Bipul K, Bhuyan Ashok K
Department of Endocrinology, Gauhati Medical College and Hospital, Guwahati, Assam, India.
Indian J Endocrinol Metab. 2022 Jan-Feb;26(1):73-78. doi: 10.4103/ijem.ijem_335_21. Epub 2022 Apr 27.
Adrenal incidentalomas (AIs) are seen in around 2% of apparently healthy individuals. These require careful evaluation for the hormone excess state and the presence of malignancy prior to intervention.
To study the clinical, biochemical, and imaging characteristics of the patients with AI and correlate the diagnosis with the histopathology findings in patients undergoing surgery.
Retrospective observational study.
Patients with adrenal incidentaloma presenting between January 2017 and January 2021 were evaluated as per guidelines provided by the European Society of Endocrinology and the European Network for the Study of Adrenal Tumors. Patients were given final diagnosis on the basis of imaging impression, hormonal activity, and biopsy results (when applicable).
Forty-eight patients were evaluated, with 25 being male, the mean age being 40.9 years (8-71), and the mean size of the mass being 6.21 (1.4-13.7) cm. Thirty-five (72.9%) of them underwent surgical excision. The most common diagnosis was myelolipoma (16), followed by pheochromocytoma (10) and adenoma (9). Nineteen patients were found to have hormone-secreting masses. Two patients with pheochromocytoma were normotensive. There was discordance between imaging diagnosis and hormonal status in two patients, with final diagnosis of pheochromocytoma. One patient with extramedullary erythropoiesis of the adrenal gland was subsequently diagnosed with sickle cell anemia and adrenal insufficiency.
The study highlights the rare possibility of discrepancy between non-contrast CT diagnosis and functional status of AI. There is also a rare possibility of extramedullary erythropoiesis presenting as AI with adrenal insufficiency. Specific evaluation for such rare possibilities should be considered in AI cases as per clinical scenario.
肾上腺偶发瘤（AIs）在约2%的看似健康的个体中可见。在进行干预之前，需要对这些患者进行仔细评估，以确定是否存在激素分泌过多状态以及是否存在恶性肿瘤。
研究肾上腺偶发瘤患者的临床、生化和影像学特征，并将诊断结果与接受手术治疗患者的组织病理学结果进行关联。
回顾性观察研究。
根据欧洲内分泌学会和欧洲肾上腺肿瘤研究网络提供的指南，对2017年1月至2021年1月期间出现肾上腺偶发瘤的患者进行评估。根据影像学表现、激素活性和活检结果（如适用）对患者进行最终诊断。
共评估了48例患者，其中男性25例，平均年龄40.9岁（8 - 71岁），肿块平均大小为6.21（1.4 - 13.7）cm。其中35例（72.9%）接受了手术切除。最常见的诊断是肾上腺髓质脂肪瘤（16例），其次是嗜铬细胞瘤（10例）和腺瘤（9例）。发现19例患者有分泌激素的肿块。2例嗜铬细胞瘤患者血压正常。2例患者的影像学诊断与激素状态不一致，最终诊断为嗜铬细胞瘤。1例肾上腺髓外造血患者随后被诊断为镰状细胞贫血和肾上腺功能不全。
该研究强调了肾上腺偶发瘤非增强CT诊断与功能状态之间存在差异的罕见可能性。肾上腺髓外造血合并肾上腺功能不全表现为肾上腺偶发瘤的情况也很罕见。对于肾上腺偶发瘤病例，应根据临床情况考虑对这些罕见可能性进行特异性评估。
