Rowe Neal E, Kumar Ravi, Schieda Nicola, Siddiqi Ferhan, McGregor Thomas, McAlpine Kristen, Violette Philippe, Bathini Varun, Eng Michael, Izard Jason
Division of Urology, Department of Surgery, University of Ottawa, Ottawa, Ontario.
Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario.
J Urol. 2023 Oct;210(4):590-599. doi: 10.1097/JU.0000000000003644. Epub 2023 Aug 9.
Incidental adrenal masses are common and require a multidisciplinary approach to evaluation and management that includes family physicians, urologists, endocrinologists, and radiologists. The purpose of this guideline is to provide an updated approach to the diagnosis, management, and follow-up of adrenal incidentalomas, with a special focus on the areas of discrepancy/controversy existing among the published guidelines from other associations.
This guideline was developed by the Canadian Urological Association (CUA) through a working group comprised of urologists, endocrinologists, and radiologists and subsequently endorsed by the American Urological Association (AUA). A systematic review utilizing the GRADE approach served as the basis for evidence-based recommendations with consensus statements provided in the absence of evidence. For each guideline statement, the strength of recommendation was reported as weak or strong, and the quality of evidence was evaluated as low, medium, or high.
The CUA working group provided evidence- and consensus-based recommendations based on an updated systematic review and subject matter expertise. Important updates on evidence-based radiological evaluation and hormonal testing are included in the recommendations. This guideline clarifies which patients may benefit from surgery and highlights where short term surveillance is appropriate.
Incidentally detected adrenal masses require a comprehensive assessment of hormonal function and oncologic risk. This guideline provides a contemporary approach to the appropriate clinical, radiographic, and endocrine assessments required for the evaluation, management, and follow-up of patients with such lesions.
肾上腺偶发瘤很常见，需要多学科方法进行评估和管理，涉及家庭医生、泌尿科医生、内分泌科医生和放射科医生。本指南的目的是提供一种更新的肾上腺偶发瘤诊断、管理和随访方法，特别关注其他协会已发表指南中存在差异/争议的领域。
本指南由加拿大泌尿外科协会（CUA）通过一个由泌尿科医生、内分泌科医生和放射科医生组成的工作组制定，随后得到美国泌尿外科协会（AUA）的认可。采用GRADE方法进行的系统评价作为基于证据的推荐依据，在缺乏证据时提供共识声明。对于每个指南声明，推荐强度报告为弱或强，证据质量评估为低、中或高。
CUA工作组基于更新的系统评价和专业知识提供了基于证据和共识的推荐。推荐中包括基于证据的放射学评估和激素检测的重要更新。本指南明确了哪些患者可能从手术中获益，并突出了短期监测适用的情况。
偶然发现的肾上腺肿块需要对激素功能和肿瘤风险进行全面评估。本指南为评估、管理和随访此类病变患者所需的适当临床、影像学和内分泌评估提供了一种现代方法。
