摘要:随着医学影像学技术的进步和人们健康体检意识的提高,肾上腺偶发瘤已成为临床上常见的疾病之一。虽 然多数肾上腺偶发瘤为良性、无功能性肿瘤,但至关重要的是泌尿外科医师如何准确诊断、鉴别偶发瘤的良恶 性,以及是否伴有内分泌功能障碍,从而为下一步的治疗选择正确的措施。论文结合国内外相关文献,就肾上腺 偶发瘤的诊疗方面作一总结。
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李春建,王健明. 肾上腺偶发瘤的诊疗进展[J]. 泌尿外科杂志(电子版),2021,13(2):92-95. DOI:10.3969/j.issn.1674-7410.2021.02.020.
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肾上腺偶发瘤 (adrenal incidentaloma,AI) 是 指在不是针对肾上腺相关疾病的前提条件下,行胸 部或者腹部等相关影像学检查,而无意间发现的直 径≥1 cm的无症状的肾上腺肿物[1] 。随着影像学技术 的进步与发展,临床上越来越多的 AI 患者被发现。 有研究报道,AI 中良性和惰性的比例高达 80%以 上,但仍有一部分为恶性肿瘤,可能出现或存在内 分泌功能而导致相关临床症状[1] 。如何准确地定性并 判断是否需要早期临床干预至关重要[2] 。
1 流行病学
2 临床表现
3 诊断
3.1 AI的定位诊断
3.1.1 超声
3.1.2 CT
3.1.3 MRI
3.2 AI的定性诊断
3.2.1 皮质醇增多症内分泌检查
3.2.2 嗜铬细胞瘤的内分泌检查
3.2.3 原发性醛固酮增多症的内分泌检查
3.2.4 雄激素浓度的测定
3.3 细针穿刺活检
4 AI 的手术治疗
5 随访
5 随访
目前临床对于 AI的随访尚有争议,缺乏一个统 一的检测标准确定 AI是否需要手术治疗。AI的随访 应当有计划地开展影像学和内分泌学方面的检查, 并注意其动态变化结果。
当肿瘤直径<2 cm 且考虑为典型的多脂肾上腺 腺瘤,如果肿瘤在超过 1年的时间内大小没有明显的 变化,建议不需进一步随访[13] ;当偶发瘤较大或肿瘤 的形态特征不明确,建议在第1年3~6个月复查1次, 以后每年复查 1次;在 4年的规律随访期内,AI性状 稳定且排除恶性可能的情况下,可以终止随访。对 于偶发瘤直径<3 cm且无内分泌功能的患者推荐每年 复查 1次相关内分泌情况;当肿瘤直径>3 cm 或有轻 微的内分泌症状,在第1年3~6个月复查1次,以后改 为每年复查 1次。对于无内分泌功能的肾上腺偶发瘤 患者在规律 3~5年的随访后没有明显变化,可取消 相关内分泌方面的检查。在随访过程中,如果患者 内分泌功能增多或者发现肿瘤明显增大,推荐积极 手术治疗。
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