Owei Lily, Wachtel Heather
Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Ann Surg Oncol. 2025 Apr 30. doi: 10.1245/s10434-025-17296-8.
Adrenal incidentalomas are adrenal masses ≥ 1 cm discovered on imaging studies for unrelated clinical conditions. The prevalence of adrenal incidentalomas has increased as a byproduct of the widespread use of cross-sectional imaging, particularly in older adults. The clinical significance of adrenal incidentalomas varies based on tumor size, hormonal activity, and imaging characteristics. While most adrenal incidentalomas are benign and asymptomatic, a significant minority are hormonally active or malignant, necessitating careful evaluation and management. Adrenal hormone secretion can have significant clinical implications. Biochemical testing is crucial to assess for hormone excess, including steroid hormones (mineralocorticoids, glucocorticoids, and androgens), which are made in the adrenal cortex, as well as catecholamines, which are made in the adrenal medulla. Non-contrast computed tomography (CT) is the preferred modality for evaluating adrenal nodules as it allows for assessment of tissue density in Hounsfield units (HU). Benign lesions typically have an homogeneous appearance with HU ≤ 10. Contrast-enhanced CT with delayed washout can help differentiate benign tumors from malignant tumors. Tumors ≥ 4 cm, or those with indeterminate features may require further imaging, such as magnetic resonance imaging (MRI) or positron emission tomography (PET)/CT. The management of adrenal incidentalomas is determined by hormonal secretion and imaging characteristics. Surgical resection is recommended for functional tumors and those that are suspicious for malignancy, including tumors ≥ 4 cm in size and those with rapid growth. Non-functional tumors < 4 cm may undergo imaging surveillance. The goal of this review is to summarize the contemporary literature and guidelines on adrenal incidentalomas, and to describe the key principles regarding evaluation and management.
肾上腺偶发瘤是在因无关临床情况进行影像学检查时发现的直径≥1厘米的肾上腺肿块。随着横断面成像技术的广泛应用，尤其是在老年人中的应用，肾上腺偶发瘤的患病率有所增加。肾上腺偶发瘤的临床意义因肿瘤大小、激素活性和影像学特征而异。虽然大多数肾上腺偶发瘤是良性且无症状的，但有相当一部分是有激素活性的或恶性的，因此需要仔细评估和管理。肾上腺激素分泌可产生重大的临床影响。生化检测对于评估激素过量至关重要，包括肾上腺皮质产生的类固醇激素（盐皮质激素、糖皮质激素和雄激素）以及肾上腺髓质产生的儿茶酚胺。非增强计算机断层扫描（CT）是评估肾上腺结节的首选方式，因为它可以以亨氏单位（HU）评估组织密度。良性病变通常外观均匀，HU≤10。延迟洗脱的增强CT有助于区分良性肿瘤和恶性肿瘤。直径≥4厘米的肿瘤或具有不确定特征的肿瘤可能需要进一步的影像学检查，如磁共振成像（MRI）或正电子发射断层扫描（PET）/CT。肾上腺偶发瘤的管理取决于激素分泌和影像学特征。对于功能性肿瘤以及那些怀疑为恶性的肿瘤，包括直径≥4厘米的肿瘤和生长迅速的肿瘤，建议进行手术切除。直径<4厘米的无功能肿瘤可进行影像学监测。本综述的目的是总结关于肾上腺偶发瘤的当代文献和指南，并描述评估和管理的关键原则。
