肾上腺意外瘤指南Adrenal Incidentaloma guidelines

1、Adrenal Incidentaloma guidelines AACE/AAES Management of the clinically inapparent adrenal mass (incidentaloma). NIH State-of-the-Science Conference Statement Feb 4-6, 2002. 024680910192029303940495059606970Age(y)Patient(%)Endocrine and Metabolism Clinics of North America . 2000; 29(1):159-185http:/

2、/sealion/view_photo.php?set_albumName=album265&id=Adrenal/sealion/view_photo.php?set_albumName=album265&id=AdrenalPrimary AldosteronismCushings SyndromeDHEA-sPheochromocytomaMantero et al. 85 (2): 637. (2000) Allolio, B., Adrenal Incidentalomas.Adr

3、enal Disorders, ed. C.G. Margioris AN. 2001, Totowa: Humana Press Inc. A summary of the literaturevNonfunctioning adenoma Approximately 80% vSubclinical Cushing syndrome (SCS), 5%vPheochromocytoma 5%vAldosteronoma 1%vadrenocortical carcinoma (ACC) 5 % vMetastatic lesion 2.5%vGanglioneuromas, myeloli

4、pomas,or benign cysts考虑是否手术治疗之前准确的功能诊断非常必要 v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。v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。v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。v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

5、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 adrenalectomy is recommended.T

6、auchmanova L, et. al. Patients with subclinical Cushings syndrome due to adrenal adenoma have increase cardiovascular risk. JCEM 2000; 85:1440.Silent 8 cm pheoJAMA 2002Presented at the First International meeting on Adrenal Disease, 2002Braz J Med Biol Res 33(10) 2000When the test is negative, no ot

7、her tests are needed.Management of the clinically inapparent adrenal mass (incidentaloma).NIH State-of-the-Science Conference Statement Feb 4-6, 2002midnight salivary cortisol, or a 2-day low-dose dexamethasone suppression testmidnight salivary cortisol, or a 2-day low-dose dexamethasone suppression testcomplex solid and cystic, calcified massManagement of the clinically inapparent adrenal ma