Caplan R H, Strutt P J, Wickus G G
Section of Endocrinology, Gundersen/Lutheran Medical Center, La Crosse, Wis.
Arch Surg. 1994 Mar;129(3):291-6. doi: 10.1001/archsurg.1994.01420270067016.
To determine the frequency of subclinical hormone secretion in incidentally discovered adrenal masses.
We reviewed the radiologic reports of 1779 consecutive computed tomographic scans of the chest, abdomen, and pelvis.
Regional referral medical center.
Eighty-nine patients with abnormalities of one or both adrenal glands were identified. Patients with nonadrenal gland malignant neoplasms, primary aldosteronism, adrenal hemorrhage, and death or severe illness were not investigated. The final study group consisted of 26 patients with incidentally discovered adrenal masses.
Aldosterone secretion was assessed by measuring plasma renin activity and the plasma aldosterone concentration in patients with unexplained hypokalemia. We evaluated cortisol secretion by performing a 1-mg overnight dexamethasone suppression test and by measuring the corticotropin concentration at 8 AM by a sensitive method. In patients with low corticotropin values, we also measured the 24-hour urinary excretion of free cortisol and 17-ketosteroids and assessed diurnal variation by measuring plasma cortisol concentrations at 8 AM and 4 PM. Adrenal medullary function was studied by measuring urinary free catecholamines.
One patient had unrecognized primary aldosteronism, two patients had elevated free catecholamine excretion, and three patients (12%) had subclinical Cushing's syndrome.
Based on our observations and a review of the literature, we conclude that subclinical hormone secretion, especially cortisol secretion, is more common in patients with incidentally discovered adrenal masses than previously appreciated. Surgeons and anesthesiologists must be alert to the possibility that adrenal insufficiency or a hypertensive crisis may develop in the perioperative period in patients with incidentally discovered adrenal masses.
确定偶然发现的肾上腺肿块中亚临床激素分泌的频率。
我们回顾了1779例连续的胸部、腹部和骨盆计算机断层扫描的放射学报告。
地区转诊医疗中心。
识别出89例一侧或双侧肾上腺异常的患者。未对患有非肾上腺恶性肿瘤、原发性醛固酮增多症、肾上腺出血以及死亡或重症患者进行调查。最终研究组由26例偶然发现肾上腺肿块的患者组成。
通过测量不明原因低钾血症患者的血浆肾素活性和血浆醛固酮浓度来评估醛固酮分泌。我们通过进行1毫克过夜地塞米松抑制试验以及用敏感方法测量上午8点的促肾上腺皮质激素浓度来评估皮质醇分泌。对于促肾上腺皮质激素值低的患者，我们还测量了24小时尿游离皮质醇和17 - 酮类固醇的排泄量，并通过测量上午8点和下午4点的血浆皮质醇浓度来评估昼夜变化。通过测量尿游离儿茶酚胺来研究肾上腺髓质功能。
1例患者患有未被识别的原发性醛固酮增多症，2例患者尿游离儿茶酚胺排泄量升高，3例患者（12%）患有亚临床库欣综合征。
基于我们的观察以及对文献的回顾，我们得出结论，偶然发现的肾上腺肿块患者中亚临床激素分泌，尤其是皮质醇分泌，比之前认识到的更为常见。外科医生和麻醉医生必须警惕偶然发现肾上腺肿块的患者在围手术期可能发生肾上腺功能不全或高血压危象的可能性。
