肾上腺偶发瘤_NEJM临床实践音频

Adrenal Incidentaloma

【内容简介】

A 42-year-old woman has been in a motor vehicle accident in which her seat belt tightened. She has upper abdominal pain and is evaluated with computed tomography (CT). This imaging shows no evidence of intraabdominal trauma but reveals a well-circumscribed and homogeneous left adrenal mass that is 3.2 cm in diameter. The mass has an attenuation value of 7 Hounsfield units on unenhanced CT. The patient’s history is remarkable for obesity and newly diagnosed mild hypertension. On physical examination, the blood pressure is 142/90 mm Hg. There is sternal and upper abdominal bruising but no striae, moon facies, or fat accumulation over the dorsocervical spine (“buffalo hump”). How should this patient be further evaluated and treated?

Adrenal incidentaloma is defined as a clinically unapparent adrenal lesion (≥1 cm in diameter) that is detected on imaging performed for indications other than evaluation for adrenal disease. This definition excludes patients who are undergoing screening and surveillance because of hereditary syndromes or those with known extraadrenal cancer who are undergoing imaging for staging or during follow-up after treatment.

Among adults, the prevalence of adrenal incidentaloma has been reported to be 1 to 6%, and the prevalence has increased with the growing use of and technological advances in imaging and with the aging of the population. The prevalence is higher among older adults, with a peak (≤7%) in the fifth to seventh decades. Most adrenal incidentalomas are nonfunctioning benign tumors; 75% are nonfunctioning cortical adenomas. However, there are important clinical consequences in a subset of these masses. For example, approximately 14% of adrenal incidentalomas are functional tumors that secrete excess cortisol, aldosterone, or (rarely) both. Other masses with clinical significance are pheochromocytomas (approximately 7%) and primary adrenal cancers or metastases to the adrenal glands (approximately 4%). When an adrenal mass is incidentally identified, the key clinical questions are whether it is functioning and whether it is malignant. These determinations are guided by clinical and radiographic features and biochemical assessments.

肾上腺偶发瘤，是在非肾上腺疾病评估的影像学检查时被发现的、临床表现不明显的肾上腺病变(直径≥1厘米)。

据报道，成年人肾上腺偶发瘤的发病率为1- 6%，随着影像学的不断应用和技术进步以及人口老龄化，肾上腺偶发瘤的发病率有所上升。偶然发现肾上腺肿块时，关键问题在于它是否有功能？是否为恶性？

聆听本音频，可参照Adrenal Incidentaloma; Electron Kebebew, M.D.;N Engl J Med 2021; 384:1542-1551