| OBJECTIVE: To explore the distribution, diagnosis and treatment of adrenal disease. And to analyse the aetiology, clinical presentation and differential diagnosis of adrenal hematoma.SUBJECTS AND RESEARCH:All the patients who had underwent adrenal surgery between Mar 1993 and Jan 2002 in our hospital were observed. The medical records of these patients were reviewed for data of the general conditon, clinical presentation, image examination for the localization, laboratory data, surgical management, pathology diagnosis and so on. These cases were classified by pathology diagnosis. Professional staffs completed this assignment with special tables. All the data were recorded in EXCELL for further analysis. Articles related to adrenal hematoma from CBMdisc and CMCC were meta-analyzed.RESULTS:1. 282 cases with definite pathology diagnosis fulfilled our study criteria. From the data we could see that the number of adrenal surgery increased annually since 1993, and the number in 2001 increased fourfold compared with 1994. There was no difference in left and right lesion in general, but all the 13 cases of myelolipoma were on the right. The 282 patients consisted of 135 ( 47.9 % ) male and 147 ( 52.1 % ) female with an average age of 43.6?13.0 years old (3 ~ 75 years old). There was a sex difference in cushing's syndrome (male/female=l/5.3). General speaking, the adrenal cortex disease were most common, medulla disease were second and mesenchymal disease third in adrenal. Main of them were benign disease, and malignant disease accounted for only 12.1%.Functional adrenal disease accounted for 58.9%. Consistency was 68.1% between diagnosis of preoperation and pathology diagnosis. The average diameter of benign adrenal tumors was 4.3 ?2.9cm ( 0.9 ~ 16cm ) with a median diameter 3.5cm. The average diameter of malignant adrenal tumors was 8.8 ?4.1cm(1.7 ~ 22.5cm ) with a median diameter 9cm, which was bigger than the benign ( PO.OOO ). The only adrenal malignant tumor with a diameter less than 4 was transferred clear cell carcinoma, the diameter was 1.7cm. Aldosterone-producing adenoma was the most common adrenal disease, pheochromocytoma was the second, and unfunctional cortex adenoma was the third. 82 patients with aldosteronism and 27 with cushing's syndrome had typical clinical presentation, but there also had 8 ( 13.8% ) patients with pheochromocytoma didn't have typical clinical presentation, and 6 ( 10.3 % ) were found on health examination. 31.6 % of cortex tumors, 41.0% of medulla tumors and 95.7% of mesenchymal tumors were accidentalomas. Unfunctional cortex adenoma was the most common accidentalomas, medulla tumor was second and mesenchymal tumor was third. Except for functional adrenal tumors, 18 patients with unfunctional adrenal tumors had elevated 24-h urinary adrenal hormone. Among 282 cases, 66.7% had absolute surgical indication, and 32.6% had relative surgical indication.2. Pathological examination revealed 4 cases of adrenal hematomas among 282 cases of adrnal surgery in our hospital since 1993. They consisted of two male and two female, aged between 28 and 60 years old, with a maximum diameter of 2.2 ~ 5cm. Two were on the right and had trauma history, which were suspected to be adrenal tumors and operated after endocrinology and imaging examination. After surgery, pathological examination revealed it's adrenal hematoma. Another two were on the left and led to morphological abnormality of left limbs of adrenal glands, which were encountered at surgery of ipsilateral nephrectomy for hydronephrosis or pyonephrosis and resected incidentally.3.46 cases with diagnosis of adrenal hematoma in 7 articles since 1979 were reviewed, among them 35 ( 76.1 % ) were male and 11 (23.9 % ) were female. Diameter of adrenal hematomas were between 0.7cm and 12cm. Of the 46 cases, 11 ( 23.9% )were left, 35 ( 76.1 % ) were right. Trauma history were identified in 36 cases (78.3%). 12 (26.1%) were misdiagnosed as adrenal tumors and operated. 34 ( 73.9 % ) were followed up. According to these ar... |
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