Hu Andrew C, Passman Jesse E, Wachtel Heather
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA.
Clin Med Insights Endocrinol Diabetes. 2025 Jun 3;18:11795514251345267. doi: 10.1177/11795514251345267. eCollection 2025.
Incidental adrenal cysts are quite rare and thus can present a diagnostic conundrum for even experienced clinicians. Here, we present the case of a patient with an incidentally identified 5 cm adrenal mass. Her evaluation was notable for evidence of mild autonomous cortisol secretion and imaging findings concerning for malignancy with possible invasion of the inferior vena cava. Adrenalectomy was performed; pathology ultimately demonstrated an adrenal cortical pseudocyst without evidence of malignancy. All patients with solid, high-density, or large adrenal tumors require further imaging for characterization and biochemical testing for hormone secretion. While simple, low-density adrenal adenomas and cysts do not require further imaging evaluation beyond non-contrast CT, mixed cystic and solid lesions or pseudocystic lesions should be evaluated similarly to solid tumors, with the caveat that pseudocysts cannot always be well-differentiated from benign cysts on imaging. All adrenal incidentalomas should be evaluated with a biochemical work-up to assess hormonal activity. Tumors suspicious for malignancy require surgical excision. Patients with benign, hormonally active tumors should be managed surgically or medically, according to their primary pathology.
偶然发现的肾上腺囊肿非常罕见，因此即使对于经验丰富的临床医生来说，也可能构成诊断难题。在此，我们报告一例偶然发现肾上腺有5厘米肿块的患者。她的评估结果值得注意，有轻度自主性皮质醇分泌的证据，影像学检查结果提示有恶性可能且可能侵犯下腔静脉。实施了肾上腺切除术；病理结果最终显示为肾上腺皮质假性囊肿，无恶性证据。所有实性、高密度或较大的肾上腺肿瘤患者都需要进一步进行影像学检查以明确特征，并进行激素分泌的生化检测。虽然单纯的低密度肾上腺腺瘤和囊肿在非增强CT检查后不需要进一步的影像学评估，但混合性囊实性病变或假性囊肿性病变应与实性肿瘤进行类似的评估，需要注意的是，在影像学上假性囊肿并不总能与良性囊肿很好地区分。所有肾上腺意外瘤都应进行生化检查以评估激素活性。怀疑为恶性的肿瘤需要手术切除。良性、有激素活性的肿瘤患者应根据其原发病理情况进行手术或药物治疗。
