Domínguez Gadea L, Díez L, Lancha C, Zurita P, Mitjavila M
Sección de Medicina Nuclear, Hospital Ramón y Cajal, Madrid.
Rev Clin Esp. 1993 May;192(9):428-30.
It is described the case of a patient with Ovarian Cystadenoma in whom a 3.5 cm nodular lesion was accidentally detected in her left suprarenal gland. She had no signs of hypercortisolism or any other suprarenal pathology and was symptomless. Determinations in the urine of 24 hours of Cortisol, Adrenaline and Noradrenaline, 17-ketosteroids and Tetrahydroaldosterone were normal. Daily rhythm and plasmatic determinations of ACTH, cortisol and 11-deoxycortisol were normal. The Dexamethasone suppression test was also normal. In the suprarenal gammagraphy it appeared an intense captation by left suprarenal without visualization of right gland. A left suprarenalectomy was performed and the anatomopathological analysis showed a clear cell corticoadrenal adenoma. Therefore the only data of the function of suprarenal adenoma was the one coming from gammagraphy. We thought that the adenoma was responsible of practically all the corticoadrenal function without reaching pathological levels, meeting the criteria of "pre-Cushing" syndrome or subclinical Cushing, due to the fact that the contralateral gland was not seen in the gammagraphy. Therefore in the characterization of certain tumors which appear clinically and biochemically as non functional, the suprarenal gammagraphy could be a technique of great usefulness for the diagnosis.
本文描述了一例卵巢囊腺瘤患者，其左肾上腺意外发现一个3.5厘米的结节性病变。她没有皮质醇增多症或任何其他肾上腺病变的迹象，也没有症状。24小时尿皮质醇、肾上腺素、去甲肾上腺素、17-酮类固醇和四氢醛固酮测定均正常。促肾上腺皮质激素、皮质醇和11-脱氧皮质醇的日节律和血浆测定也正常。地塞米松抑制试验也正常。肾上腺γ照相显示左肾上腺摄取强烈，右肾上腺未显影。行左肾上腺切除术，病理分析显示为透明细胞肾上腺皮质腺瘤。因此，肾上腺腺瘤功能的唯一数据来自γ照相。我们认为，由于γ照相中未见到对侧肾上腺，该腺瘤几乎承担了所有肾上腺皮质功能，但未达到病理水平，符合“库欣前期”综合征或亚临床库欣的标准。因此，在某些临床和生化表现为无功能的肿瘤的特征性诊断中，肾上腺γ照相可能是一种非常有用的诊断技术。
