Sweeney Ann T, Hamidi Oksana, Dogra Prerna, Athimulam Shobana, Correa Ricardo, Blake Michael A, McKenzie Travis, Vaidya Anand, Pacak Karel, Hamrahian Amir H, Bancos Irina
Division of Endocrinology, Department of Medicine, St Elizabeth's Medical Center, Brighton, Massachusetts.
Division of Endocrinology and Metabolism, University of Texas Southwestern Medical Center, Dallas, Texas.
Endocr Pract. 2024 Oct;30(10):987-1002. doi: 10.1016/j.eprac.2024.06.015. Epub 2024 Aug 3.
This white paper provides practical guidance for clinicians encountering bilateral adrenal masses.
A case-based approach to the evaluation and management of bilateral adrenal masses. Specific clinical scenarios presented here include cases of bilateral adrenal adenomas, hemorrhage, pheochromocytomas, metastatic disease, myelolipomas, as well as primary bilateral macronodular adrenal hyperplasia.
Bilateral adrenal masses represent approximately 10% to 20% of incidentally discovered adrenal masses. The general approach to the evaluation and management of bilateral adrenal masses follows the same protocol as the evaluation of unilateral adrenal masses, determined based on the patient's clinical history and examination as well as the imaging characteristics of each lesion, whether the lesions could represent a malignancy, demonstrate hormone excess, or possibly represent a familial syndrome. Furthermore, there are features unique to bilateral adrenal masses that must be considered, including the differential diagnosis, the evaluation, and the management depending on the etiology. Therefore, considerations for the optimal imaging modality, treatment (medical vs surgical therapy), and surveillance are included. These recommendations were developed through careful examination of existing published studies as well as expert clinical opinion consensus.
The evaluation and management of bilateral adrenal masses require a comprehensive systematic approach which includes the assessment and interpretation of the patient's clinical history, physical examination, dynamic hormone evaluation, and imaging modalities to determine the key radiographic features of each adrenal nodule. In addition, familial syndromes should be considered. Any final treatment options and approaches should always be considered individually.
本白皮书为临床医生处理双侧肾上腺肿块提供实用指导。
采用基于病例的方法对双侧肾上腺肿块进行评估和管理。此处呈现的具体临床病例包括双侧肾上腺腺瘤、出血、嗜铬细胞瘤、转移性疾病、髓脂肪瘤以及原发性双侧大结节性肾上腺增生。
双侧肾上腺肿块约占偶然发现的肾上腺肿块的10%至20%。双侧肾上腺肿块评估和管理的一般方法遵循与单侧肾上腺肿块评估相同的方案，根据患者的临床病史、检查以及每个病变的影像学特征来确定，这些病变是否可能代表恶性肿瘤、显示激素过多或可能代表家族综合征。此外，双侧肾上腺肿块有一些独特的特征必须予以考虑，包括鉴别诊断、根据病因进行的评估和管理。因此，还包括对最佳成像方式、治疗（药物治疗与手术治疗）以及监测的考虑。这些建议是通过仔细审查现有已发表的研究以及专家临床意见共识而制定的。
双侧肾上腺肿块的评估和管理需要一种全面系统的方法，包括对患者临床病史、体格检查、动态激素评估和成像方式的评估与解读，以确定每个肾上腺结节的关键影像学特征。此外，应考虑家族综合征。任何最终的治疗选择和方法都应始终单独考虑。
