A survey on adrenal incidentaloma in Italy
A survey on adrenal incidentaloma in Italy
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DOI：
10.1210/jc.85.2.637
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发表时间：
2000-02-01
影响因子：
5.8
通讯作者：
Angeli, A
中科院分区：
文献类型：
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作者：
Mantero, F;Terzolo, M;Angeli, A
这项研究的目的是在意大利内分泌学协会的赞助下，对偶尔发现的肾上腺肿块[肾上腺偶发瘤(AI)]进行一次全国性调查。这项对AI患者的多中心和回顾性评估包括1980年至1995年在26个中心收集的1096例病例。相关信息是通过专门设计的问卷获得的。在收到的1096份表格中，有1004份保留下来进行最后分析。患者为男性420人，女性584人，年龄15-86岁(中位数58岁)。肿块大小(CT测量)范围为0.5-25 cm(中位数3.0 cm)。激素检查显示85%的肿块为非高分泌型，9.2%为亚临床库欣综合征，4.2%为嗜铬细胞瘤，1.6%为醛固酮样瘤。380例患者行肾上腺切除术，切除皮质腺瘤198例(52%)，皮质癌47例(12%)，嗜铬细胞瘤42例(11%)，以及其他少见的肿瘤类型。癌症患者明显比腺瘤患者年轻(中位数46岁；范围17-84岁；比57岁，16-83岁；P=0.05)。腺瘤明显小于癌(3.5，1-15vs.7.5，2.6-25 cm；P<；0.001)，以4.0 cm为界值对良、恶性肿瘤的鉴别敏感性最高(93%)。亚临床库欣综合征患者的激素检查显示，79%的患者基础ACTH水平较低，73%的患者在注射地塞米松后皮质醇不受抑制，75%的患者尿游离皮质醇高于正常，43%的患者皮质醇节律紊乱，55%的患者对CRH的ACTH反应迟钝。只有43%的嗜铬细胞瘤患者有高血压，86%的患者尿儿茶酚胺升高。结果表明，肿块大小是区分AI良恶性的最可靠的指标。对于AI大于4.0厘米的患者，应推荐肾上腺切除术，因为恶性风险增加，尤其是年轻患者。应对所有患者进行内分泌评估，以确定激素过剩的静默状态。
The aim of this study was to perform a national survey on occasionally discovered adrenal masses [adrenal incidentalomas (AI)] under the auspices of the Italian Society of Endocrinology. This multicentric and retrospective evaluation of patients with AI includes 1096 cases collected in 26 centers between 1980 and 1995. Relevant information was obtained by means of a specifically tailored questionnaire. Of the 1096 forms received, 1004 were retained for final analysis. Patients were 420 males and 584 females, aged between 15-86 yr (median, 58 yr). Mass size (computed tomography measurement) ranged from 0.5-25 cm (median, 3.0 cm). Hormonal work-up demonstrated that 85% of the masses were nonhypersecretory, 9.2% were defined as subclinical Cushing's syndrome, 4.2% were pheochromocytomas, and 1.6% were aldosteronomas. Adrenalectomy was performed in 380 patients with removal of 198 cortical adenomas (52%), 47 cortical carcinomas (12%), 42 pheochromocytomas (11%), and other less frequent tumor types. Patients with carcinoma were significantly younger than patients with adenoma (median, 46; range, 17-84; vs. 57, 16-83 yr; P = 0.05). Adenomas were significantly smaller than carcinomas (3.5, 1-15 vs. 7.5, 2.6 -25 cm; P < 0.001), and a cut-off at 4.0 cm had the highest sensitivity (93%) in differentiating between benign and malignant tumors. Hormonal work-up of patients with subclinical Cushing's syndrome showed low baseline ACTH in 79%, cortisol unsuppressibility after I mg dexamethasone in 73%, above normal urinary free cortisol in 75%, disturbed cortisol rhythm in 43%, and blunted ACTH response to CRH in 55%. Only 43% of patients with pheochromocytoma were hypertensive, and 86% showed elevated urinary catecholamines. All patients with aldosteronoma were hypertensive and had suppressed upright PRA.These results indicate that mass size is the most reliable variable in separating benign from malignant AI. Adrenalectomy should be recommended for AI greater than 4.0 cm because of the increased risk of malignancy, especially in young patients. Endocrine evaluation should be performed in all patients to identify silent states of hormone excess.