Clinical Analysis Of Differential Diagnosis Between Massive Adrenocortical Carcinoma And Pheochromocytoma

Objective : To analyze the general information,clinical features and auxiliary examination characteristics of large volume adrenocortical carcinoma（ACC）and pheochromocytoma（PHEO）,and to explore the key points of differential diagnosis between the two groups.Methods : Retrospective analysis: from January 2018 to December 2021,the pathological diagnosis of menstruation in Bethune First Hospital of Jilin University was confirmed as ACC and PHEO.A total of 53 patients with tumors larger than 6cm were collected,including 20 cases in ACC group and 33 cases in PHEO group.The clinical data,clinical characteristics,biochemistry and auxiliary examinations were collected.According to the characteristics of the collected data,appropriate statistical methods were used,and single factor t-test and X-test were carried out ~2 In the test,the single factor that is considered to be different will be analyzed by logistic stepwise regression,and the receiver operating characteristic curve（ROC）will be diagnosed and analyzed according to the multi factor results to compare the differences between the two diseases.Results:1.There was no statistical difference between the two groups in terms of general data,gender,location,age and BMI.2.In terms of clinical characteristics: 5 cases（25%）of ACC combined with hypertension and 20 cases（60.61%）of PHEO combined with hypertension,the difference was statistically significant（P < 0.05）.ACC combined with diabetes mellitus in 3 cases,PHEO combined with diabetes in 15 cases,the difference was statistically significant（P < 0.05）,but there was no statistical significance in multivariate analysis.3.Biochemical examination: the levels of renin and angiotensin II in PHEO group were higher than those in ACC group（P < 0.05）.However,there was no statistical significance in multivariate analysis.The value of 24-hour urinary free cortisol in ACC group was higher than that in PHEO group（P < 0.05）.In multivariate analysis,24-hour urinary free cortisol（P = 0.009）was an independent factor for identification.4.Auxiliary examination: in CT images,the P values of the two groups were less than 0.05 in the presence of central low-density area and calcification,but there was no significance in multivariate analysis.The number of internal blood vessels and the maximum diameter of tumor in ACC group were more and larger than those in PHEO group,and the difference was significant in multivariate analysis（P < 0.05）.The values of arterial phase and CT difference（artery vein）in PHEO group were higher than those in ACC group（P < 0.05）,but only CT difference（artery vein）was significant in multivariate analysis（P = 0.041）.5.ROC diagnosis: the results of multivariate stepwise analysis showed that the maximum diameter of CT tumor（P =0.011）,24-hour urinary free cortisol（P = 0.009）,internal blood vessel routing on CT（P = 0.005）,and CT difference（artery vein）（P = 0.041）were independent influencing factors for differentiation.The diagnostic results of ROC showed that the CT difference and blood vessel routing were meaningless in the model.The AUC values corresponding to the maximum diameter of CT tumor and 24-hour urinary free cortisol were 0.749 and 0.786,respectively.The corresponding optimal bounds were 8.3cm（sensitivity 0.75,specificity 0.697）and 618.96noml/24h（sensitivity 0.7,specificity 0.758）.Finally,the maximum diameter of CT tumor and 24-hour urinary free cortisol were jointly diagnosed.The results of joint diagnosis showed that the AUC was 0.88,and the sensitivity and specificity were 0.8and 0.848 respectively,indicating that the effect of combined diagnosis was better than that of single diagnosis.Conclusions: The clinical comparison between large volume（≥ 6cm）adrenocortical carcinoma and pheochromocytoma shows that the maximum diameter of the tumor,24-hour urinary free cortisol,internal blood vessel routing and CT difference（artery vein）are important independent factors for differential diagnosis.When the diameter of the tumor is larger than 8.3cm and 24-hour urinary free cortisol is greater than 618.96（noml / 24h）,adrenocortical carcinoma is more likely to be diagnosed.