肾上腺意外瘤指南.pptVIP

肾上腺意外瘤指南 （优选）肾上腺意外瘤指南 Definition“Mass lesion greater than 1 cm in diameter discovered “accidentally” during a radiographic examination performed for indications other than an evaluation for adrenal disease.”Management of the clinically inapparent adrenal mass (incidentaloma). NIH State-of-the-Science Conference Statement Feb 4-6, 2002. PrevalenceAutopsies: 87,065 cases: 6% with adrenal adenomasAbdominal CT (61,054 CT scans reviewed): 4% with adrenal adenomasNow approaches the 8.7% incidence reported in autopsy series Incidence Increases with AgeEndocrine and Metabolism Clinics of North America . 2000; 29(1):159-185 Three Main QuestionsIs the adrenal mass hormonally active?Is the mass benign or malignant?Does the patient have a history of a previous malignant lesion? Is it metastatic? Anatomy Anatomy AnatomyPrimary AldosteronismCushing’s SyndromeDHEA-sPheochromocytoma Frequency of FindingsMulticenter study of 1096 casesNonfunctioning adenoma: 85%Subclinical Cushing’s syndrome: 9%Pheochromocytoma: 4%Aldosteronomas: 2%Mantero et al. 85 (2): 637. (2000) Frequency of FindingsAllolio, B., Adrenal Incidentalomas.Adrenal Disorders, ed. C.G. Margioris AN. 2001, Totowa: Humana Press Inc. A summary of the literatureNonfunctioning adenoma Approximately 80% Subclinical Cushing syndrome (SCS), 5%Pheochromocytoma 5% Aldosteronoma 1%adrenocortical carcinoma (ACC) 5 % Metastatic lesion 2.5%Ganglioneuromas, myelolipomas,or benign cysts 考虑是否手术治疗之前准确的功能诊断非常必要 嗜铬细胞瘤要进行认真的术前准备以避免术中和术后的发作和死亡。原发性醛固酮增多症的患者需要明确是否存在肾上腺皮质增生及无功能的肾上腺腺瘤。肾上腺源性Cushing综合征的患者在行切除术后可能发生肾上腺皮质功能不全，激素的替代以及增减治疗需要非常仔细。亚临床Cushing综合征的患者是否需要手术治疗仍存在争议。肾上腺皮质癌的患者手术前需要外科医师和内分泌科医师或肿瘤科医师共同协商决定切除的方式，因为首次切除的效果是生存率的主要预测因素。超过4cm的肾上腺无功能瘤可以考虑切除。小的髓脂肪瘤或良性的囊肿一般影像学检查即可确诊，通常不需要治疗，除非有症状可以考虑手术治疗。 Algorithm for the evaluation and management of an adrenal incidentaloma*Reimage in 3 to 6 months and annually for 1 to 2 years; repeat functional studies annually for 5 years.If mass grows more than 1cm or becomes hormonally active, then a