Xiao X R, Ye L Y, Shi L X, Cheng G F, Li Y T, Zhou B M
Department of Urology, General Hospital of PLA, Postgraduate Medical School, Beijing, China.
Br J Urol. 1998 Aug;82(2):199-205. doi: 10.1046/j.1464-410x.1998.00726.x.
To review and analyse clinical data on the diagnosis and management of patients with adrenal masses.
Patients admitted with adrenal masses between 1960 and 1995 were reviewed. The series comprised 116 males (mean age 41.4 years, SD 10.5, range 3-77) and 95 females (mean 36.9 years, SD 11.6, range 1-62); eight patients were < 14 years old and the overall mean (SD) age was 39.4 (12.8) years. The diagnosis was based on symptoms, signs, hormone levels and imaging studies. All tumours were confirmed by surgery, and pathology and results of analysis assessed statistically.
Over the last 35 years, the incidence of adrenal tumours was 1.7% of all patients admitted with genitourological diseases or 9.7% of patients with genitourinary tumours at our institution. The prevalence of adrenal tumours in males and females was similar but Cushing's syndrome was 3.1 times more frequent in females than in males and phaeochromocytoma 1.9 times more frequent in males than females. Most patients with adrenal tumour were aged 30-50 years. Of 211 adrenal tumours, 151 (72%) were functional, with a prevalence of benign tumour, and 60 (28%) were nonfunctional, with 35% malignant. There were 78 'incidentalomas' which included 18 functional tumours. Overall, 210 tumours were removed and one was explored. Correlation analysis between tumour size and character or hormone levels showed that size was significantly positively correlated with tumour character (r = 0.4010, P < 0.001), but there was no relationship between tumour size and hormonal levels. The postoperative complication rate was 3.3% and the mortality 0.5%.
Based on this analysis we recommend that computed tomography is the first method used to define and localize the adrenal masses, that hormone levels should be determined in symptomatic or asymptomatic patients with adrenal masses, and that functional adrenal tumours and solid incidentalomas of any size should be removed surgically.
回顾并分析肾上腺肿块患者的诊断及治疗的临床资料。
对1960年至1995年间收治的肾上腺肿块患者进行回顾性研究。该组患者包括116例男性（平均年龄41.4岁，标准差10.5，范围3 - 77岁）和95例女性（平均36.9岁，标准差11.6，范围1 - 62岁）；8例患者年龄小于14岁，总体平均（标准差）年龄为39.4（12.8）岁。诊断基于症状、体征、激素水平及影像学检查。所有肿瘤均经手术确诊，并对病理及分析结果进行统计学评估。
在过去35年中，肾上腺肿瘤的发病率在我院所有泌尿生殖系统疾病入院患者中占1.7%，在泌尿生殖系统肿瘤患者中占9.7%。肾上腺肿瘤在男性和女性中的患病率相似，但库欣综合征在女性中的发生率是男性的3.1倍，嗜铬细胞瘤在男性中的发生率是女性的1.9倍。大多数肾上腺肿瘤患者年龄在30至50岁之间。在211例肾上腺肿瘤中，151例（72%）为功能性肿瘤，以良性肿瘤为主，60例（28%）为无功能性肿瘤，其中35%为恶性。有78例“偶发瘤”，其中包括18例功能性肿瘤。总体而言，210例肿瘤被切除，1例进行了探查。肿瘤大小与性质或激素水平之间的相关性分析表明，大小与肿瘤性质呈显著正相关（r = 0.4010，P < 0.001），但肿瘤大小与激素水平之间无相关性。术后并发症发生率为3.3%，死亡率为0.5%。
基于本分析，我们建议计算机断层扫描是用于确定和定位肾上腺肿块的首选方法，对于有症状或无症状的肾上腺肿块患者均应测定激素水平，并且任何大小的功能性肾上腺肿瘤及实性偶发瘤均应手术切除。
