Madala Alosh, Daugherty Michael, Bratslavsky Gennady
Department of Urology, SUNY Upstate Medical University, Syracuse, New York.
Urol Pract. 2015 Nov;2(6):359-366. doi: 10.1016/j.urpr.2015.03.006. Epub 2015 Sep 1.
When a biochemically active adrenal mass is found, surgery is usually recommended. While partial adrenalectomy is increasing in popularity for small adrenal masses, it is not clear which patients will benefit from adrenal sparing to preserve adrenal function in case of contralateral adrenal pathology. We reviewed the available literature to evaluate the frequency of bilaterality of adrenal involvement with most common primary adrenal tumors and the frequency of other pathologies potentially threatening the health of the adrenal gland.
We reviewed the available PubMed® literature to evaluate the reported bilaterality of primary adrenal tumors, including hereditary and nonhereditary pheochromocytomas, aldosterone producing adenomas and cortisol producing adenomas, and identified 25 articles describing the frequency of bilaterality of adrenal masses. We also reviewed the literature to assess the etiologies of adrenal damage due to other pathological processes that may affect the adrenal gland in the life span of a patient and calculated the combined probability for adrenal damage.
Bilaterality of adrenal tumors in hereditary and nonhereditary diseases ranged from 4.25% to 80%. Hereditary pheochromocytomas were bilateral in up to 80% of cases while nonhereditary pheochromocytomas were bilateral in up to 25%. Aldosterone producing adenomas were bilateral in about 4% of cases while only case reports reported bilaterality in cortisol producing tumors. Additionally, review of other processes, such as infections, infiltrative etiologies, adrenal metastasis and others accounted for about a 1% chance of adrenal damage from all possible causes.
Partial adrenalectomy may be a valid option for patients with hereditary syndromes as there is an increased likelihood of disease in the contralateral gland. Pheochromocytomas followed by aldosterone producing adenomas appear to have the highest rate of bilateral involvement. Coupled with the possibility that an additional 1% of the population may have adrenals affected by various pathological processes, partial adrenalectomy in patients with metabolically active adrenal tumors should be considered.
当发现具有生化活性的肾上腺肿物时，通常建议进行手术。虽然对于小的肾上腺肿物，肾上腺部分切除术越来越受欢迎，但尚不清楚哪些患者将从保留肾上腺中获益，以在对侧肾上腺出现病变时保留肾上腺功能。我们回顾了现有文献，以评估最常见的原发性肾上腺肿瘤双侧肾上腺受累的频率以及其他可能威胁肾上腺健康的病变的频率。
我们回顾了PubMed®上的现有文献，以评估原发性肾上腺肿瘤（包括遗传性和非遗传性嗜铬细胞瘤、醛固酮瘤和皮质醇瘤）报告的双侧性，并确定了25篇描述肾上腺肿物双侧性频率的文章。我们还回顾了文献，以评估在患者生命过程中可能影响肾上腺的其他病理过程导致肾上腺损伤的病因，并计算肾上腺损伤的综合概率。
遗传性和非遗传性疾病中肾上腺肿瘤的双侧性范围为4.25%至80%。遗传性嗜铬细胞瘤高达80%的病例为双侧性，而非遗传性嗜铬细胞瘤高达25%为双侧性。醛固酮瘤约4%的病例为双侧性，而仅病例报告提及皮质醇瘤有双侧性。此外，对其他过程（如感染、浸润性病因、肾上腺转移等）的回顾表明，所有可能原因导致肾上腺损伤的几率约为1%。
对于患有遗传性综合征的患者，肾上腺部分切除术可能是一个有效的选择，因为对侧腺体发生疾病的可能性增加。嗜铬细胞瘤其次是醛固酮瘤似乎双侧受累率最高。再加上另外1%的人群肾上腺可能受各种病理过程影响的可能性，对于有代谢活性肾上腺肿瘤的患者应考虑肾上腺部分切除术。
