Haab F, Duclos J M, Julien J, Plouin P F
Service d'Urologie, Hôpital Saint Joseph, Paris.
Presse Med. 1994 Mar 19;23(11):511-4.
When abdominal imagery reveals bilateral adrenal tumours, diagnosis and treatment may have severe consequences leading to life-long hormone substitution. We report our series of 12 consecutive cases in order to evaluate the diagnostic procedures and propose an adapted therapeutic strategy.
Over a 5-year period we observed bilateral adrenal tumours in 12 patients (9 males and 3 females; mean age 49.2 years; range 22-67) among a population of 10,000 hypertensive subjects. Routine laboratory tests and hormonal levels were determined in all 12 patients. Abdominal computed tomography with opacification (n = 12) and magnetic resonance imagery (n = 5) was also performed. Other tests including echography and scintigraphy were performed as needed for diagnosis. All patients underwent laparotomy.
Hormone levels were normal in 6 patients and led to the diagnosis of pheochromocytosis (n = 5) and primary hyperaldosteronism (n = 1) in the others. After laparotomy, the pathology diagnosis was bilateral pheochromocytosis (n = 5), bilateral metastasis (n = 2) and benign bilateral adenoma (n = 5). In 5 cases, hormone levels were insufficient for establishing diagnosis before laparotomy. In these cases the pathology diagnosis was benign tumour in 4 and malignant tumour in 1. Images of adrenal masses (metastases) led to the diagnosis of the primary cancer in one case.
Search for pheochromocytosis and primary neoplasia, after eliminating adrenal myelolipoma and pseudotumours on the basis of the tomography images, should be the first exploration of fortuitously discovered bilateral adrenal masses. Exploratory puncture biopsy should be avoided and, for tumours greater than 30 mm, exploratory laparotomy is indicated. Tumours less than 30 mm should be followed echographically for six months to eliminate malignancy. Masses which increase in size should be explored surgically. Until larger series enable a standardized approach, malignancy should always be suspected in non-secreting bilateral tumours of the adrenal glands.
当腹部影像学检查发现双侧肾上腺肿瘤时，诊断和治疗可能会产生严重后果，导致终身激素替代治疗。我们报告连续12例病例系列，以评估诊断程序并提出合适的治疗策略。
在5年期间，我们在10000名高血压患者中观察到12例双侧肾上腺肿瘤患者（9例男性，3例女性；平均年龄49.2岁；范围22 - 67岁）。对所有12例患者进行了常规实验室检查和激素水平测定。还对12例患者进行了腹部增强计算机断层扫描，5例患者进行了磁共振成像。根据诊断需要进行了其他检查，包括超声检查和闪烁扫描。所有患者均接受了剖腹手术。
6例患者激素水平正常，其余患者诊断为嗜铬细胞瘤（5例）和原发性醛固酮增多症（1例）。剖腹手术后，病理诊断为双侧嗜铬细胞瘤（5例）、双侧转移瘤（2例）和双侧良性腺瘤（5例）。5例患者在剖腹手术前激素水平不足以确诊。在这些病例中，病理诊断为良性肿瘤4例，恶性肿瘤1例。肾上腺肿块（转移瘤）的影像在1例中导致了原发癌的诊断。
在根据断层扫描图像排除肾上腺髓样脂肪瘤和假肿瘤后，寻找嗜铬细胞瘤和原发性肿瘤应是偶然发现的双侧肾上腺肿块的首要探查方法。应避免进行探索性穿刺活检，对于直径大于30 mm的肿瘤，应进行探索性剖腹手术。直径小于30 mm的肿瘤应进行6个月的超声随访以排除恶性肿瘤。增大的肿块应进行手术探查。在有更多病例系列支持标准化方法之前，对于肾上腺非分泌性双侧肿瘤应始终怀疑有恶性可能。
