Approach to the Patient with an Adrenal Incidentaloma
Approach to the Patient with an Adrenal Incidentaloma
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DOI：
10.1210/jc.2010-0457
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发表时间：
2010-09-01
影响因子：
5.8
通讯作者：
Nieman, Lynnette K.
中科院分区：
文献类型：
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作者：
Nieman, Lynnette K.
随着胸部和腹部成像的广泛使用，意外的肾上腺肿块或偶发瘤越来越多地被发现。这些肿块可能是激素活跃的，也可能是无功能的，也可能是恶性的或良性的。临床医生必须确定肿块的性质，以决定需要什么治疗，如果有的话。CT平扫Hounsfield单位(HU)和对比度消退的测量可提供有用的诊断信息。所有患者都应该接受嗜铬细胞瘤的生化检测，无论是血儿茶酚胺还是尿儿茶酚胺。这一点在手术切除前尤其重要，对于直径大于4厘米但诊断不明确的肿块，以及其他有激素分泌或不祥影像特征的肿块，通常建议进行手术切除。高血压患者应接受生化检查，以确定是否患有高醛固酮血症。与库欣综合征特征一致的患者，如葡萄糖耐量减低、体重增加和不明原因的骨量减少，应评估皮质醇过多。在这里，地塞米松抑制试验和深夜唾液皮质醇可能比尿皮质醇的测量更受欢迎。手术切除能够逆转轻度皮质醇增多症的特征还不是很确定。对于看起来良性的肿块(50%)，小的(
Unsuspected adrenal masses, or incidentalomas, are increasingly found with the widespread use of thoracic and abdominal imaging. These masses may be hormonally active or nonfunctional and malignant or benign. Clinicians must determine the nature of the mass to decide what treatment, if any, is needed. Measurement of precontrast Hounsfield units (HU) and contrast washout on computed tomography scan provide useful diagnostic information. All patients should undergo biochemical testing for pheochromocytoma, either with plasma or urinary catecholamine measurements. This is particularly important before surgical resection, which is routinely recommended for masses larger than 4 cm in diameter without a clear-cut diagnosis and for others with hormonal secretion or ominous imaging characteristics. Hypertensive patients should undergo biochemical testing for hyperaldosteronism. Patients with features consistent with Cushing's syndrome, such as glucose intolerance, weight gain, and unexplained osteopenia, should be evaluated for cortisol excess. Here, the dexamethasone suppression test and late-night salivary cortisol may be preferred over measurement of urine cortisol. The ability of surgical resection to reverse features of mild hypercortisolism is not well established. For masses that appear to be benign (50%), small (