Bernardi Stella, Calabrò Veronica, Cavallaro Marco, Lovriha Sara, Eramo Rita, Fabris Bruno, de Manzini Nicolò, Dobrinja Chiara
Department of Medical, Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy.
SS Endocrinologia, UCO Medicina Clinica, ASUGI (Azienda Sanitaria Universitaria Giuliano Isontina), Cattinara Teaching Hospital, Strada di Fiume 447, 34149 Trieste, Italy.
J Clin Med. 2022 Jul 14;11(14):4064. doi: 10.3390/jcm11144064.
Adrenal incidentalomas are a common occurrence. Most of them are adrenocortical adenomas that do not cause harm and do not require surgery, but a non-negligible proportion of incidentalomas is represented by functionally active masses, including cortisol-secreting adenomas (12%), pheochromocytomas (3-6%), aldosterone-secreting adenomas (2-3%), as well as malignant nodules, such as adrenocortical carcinomas (2-5%), which can be either functioning or non-functioning. All patients with an adrenal incidentaloma should undergo a few biochemical screening and confirmatory tests to exclude the presence of a functionally active mass. In this approach-to-the-patient-based review, we will summarize current recommendations on biochemical evaluation and management of functionally active adrenal incidentalomas. For this purpose, we will present four case vignettes, whereby we will describe how patients were managed, then we will review and discuss additional considerations tied to the diagnostic approach, and conclude with practical aspects of patient perioperative management. To improve the perioperative management of patients with functional adrenal incidentalomas, multidisciplinary meetings are advocated.
肾上腺偶发瘤很常见。其中大多数是肾上腺皮质腺瘤，不会造成危害，也不需要手术，但仍有不可忽视比例的偶发瘤为功能活跃性肿块，包括分泌皮质醇的腺瘤（12%）、嗜铬细胞瘤（3% - 6%）、分泌醛固酮的腺瘤（2% - 3%），以及恶性结节，如肾上腺皮质癌（2% - 5%），这些肿瘤可能是功能性的，也可能是非功能性的。所有肾上腺偶发瘤患者都应接受一些生化筛查和确诊检查，以排除功能活跃性肿块的存在。在这篇基于患者诊疗过程的综述中，我们将总结目前关于功能活跃性肾上腺偶发瘤生化评估和管理的建议。为此，我们将展示四个病例 vignettes，描述患者的诊疗过程，然后回顾和讨论与诊断方法相关的其他注意事项，并以患者围手术期管理的实际问题作为总结。为改善功能活跃性肾上腺偶发瘤患者的围手术期管理，提倡多学科会诊。 （注：原文中“vignettes”未找到完全准确对应中文词汇，暂保留英文）
