| Object:To understand the clinical features of the adrenal masses in our hospital.The change trend and clinical characteristics of adrenal mass confirmed by surgery in the past 10 years were analyzed.The clinical characteristics,laboratory tests,imaging results and related risk factors of primary aldosteronism(PA)and pheochromocytoma(PCC)were mainly analyzed to help in clinical decision-making.Methods:The case data of patients with adrenal mass confirmed by surgical pathology in the First Affiliated Hospital of Shihezi University from January 2012 to December 2022 were retrospectively analyzed,including gender,age,past history,reasons for presentation,clinical symptoms and signs,laboratory examinations,imaging data,postoperative pathological diagnosis and immunohistochemistry.After hormone evaluation and confirmed by surgical pathology,the adrenal tumors were divided into functional tumors and nonfunctional tumors,and analyze the ratio of diseases and clinical characteristics;focus on the clinical characteristics,laboratory examination results,imaging data,pathological results of PCC of the most common adrenal adenoma of the adrenal gland,and analyze the risk factors related to the onset of two diseases and the factors affecting the prognosis of PCC.Results:1.Adrenal masses:(1)a total of 568 patients with adrenal masses confirmed by surgery from January 2012 to December 2022 were collected,with the prevalence increasing year by year,including 277 men(48.8%)and 291 women(51.2%),respectively,and the average age of treatment was(52.15±11.26).(2)The proportion of adrenal masses aged<20,20～29,30～39,40～49,50～59,60～69,70 and above were 0.2%,3.2%,6.5%,26.2%,38.2%,14.4%and 11.3%with age,but the overall trend was increasing.(3)Entingrine function assessment:Through the evaluation of endocrine hormones,the adrenal mass was divided into functional tumor and nonfunctional tumor,and the non-function adenoma had the highest proportion at69.8%;among functional tumors,PA still ranked first,accounting for 53.9%,followed by Cushing syndrome(CUS)in 23.2%,and PCC in 19.8%.(4)Further comparison of adrenal tumor group and nonfunctional tumor group,the results showed that BMI(P=0.035),tumor size(P<0.001),SBP(P<0.001),DBP(P=0.001),CT(P<0.001)group,and age(P=0.030),potassium(P=0.012)and GFR(P=0.015).2.Analysis of adrenal accidental tumor:(1)adrenal accidental tumor(AI)patients,accounting for 42.8%,38.3%,followed by PA in 25.5%,combined with hypertension accounted for the most(44.0%),and followed by hyperlipidemia(29.2%).(2)The highest proportion of AI visits were 99 cases(40.7%)found by routine physical examination,followed by 48 cases(19.8%)and 36 cases(14.8%)of abdominal pain and discomfort.(3)During the 10 years,the proportion of annual AI in adrenal mass was 31.3%,21.4%,44.4%,58.1%,39.7%,44.9%,53.3%,47.2%,36.3%,34.7%and 46.2%,respectively.P=0.042 after trendχ～2 test,and AI increased over time.(4)The proportion of AI in<20,20～29,30～39,40～49,50～59 and 60was 0%,4.5%,6.6%,21.0%,32.5%and 35.4%,respectively,in 86 cases(35.4%).The proportion of AI in the overall adrenal mass was:0%,61.1%,43.2%,34.2%,36.4%and 58.9%,respectively.P=0.022 afterχ～2test,the proportion of AI in adrenal masses increased linearly with age.(5)According to whether AI was combined with hypertension,the combined hypertension group age(P=0.047),BMI(P=0.009),PCC(P=0.015),CUS(P=0.046),and PA(P<0.001)were higher than the normotensive group,while blood potassium(P=0.045)and GFR(P<0.001)were lower than the normotensive group.3.Primary hyperaldosteronism:(1)Compared with the non-functional adenoma group,SBP(P<0.001),hypertension grade(P<0.001),PTH(P<0.001),aldosterone(P<0.001),ARR(P<0.001),while age(P=0.035),serum potassium(P<0.001),25(OH)D3(P=0.002),renin concentration(P<0.001),tumor size(P<0.001)were low.(2)25(OH)D3 was grouped according to quartiles,respectively:A1:<18.20nmol/l,A2:18.20～25.46nmol/l and A3:25.47～31.17 nmol/l and A4:>31.17 nmol/l.The PTH levels were higher at different 25(OH)D3 levels than in the nonfunctional adenoma group(all P<0.001).(3)The multivariate logistic regression analysis showed that SBP>160mm Hg,blood potassium<3.25mmol/l,PTH≥82.5pg/ml,25(OH)D3<24.32nmol/l,and aldosterone>135.6pg/ml were independent risk factors for PA.(4)The regression equation of the predictive model established based on the above predictors was Logit P=2.15*SBP>160mm Hg+3.01*blood potassium<3.25mmol/l+2.33*PTH≥82.5pg/ml+5.60*aldoster-one>135.6pg/ml+4.220*25(OH)D3<24.32nmol/l-7.86.The area under the ROC curve of this regression equation was 0.824(95%CI 0.818～0.941),the sensitivity was 82.5%and the specificity was 80.3%,which had a good predictive value for the risk of PA.4.Pheochromocytoma:(1)After matching the clinical characteristics of PCC and nonfunctional tumor group by propensity score matching method,58 pairs were successfully matched.(2)The Logistic regression analysis showed that hypertension(OR=5.36,95%CI 3.56～18.29,P=0.005),triad(OR=2.98,95%CI 2.06～10.32,P=0.010),tumor diameter(OR=2.23,95%CI 1.28～6.95,P=0.012),blood epinephrine(OR=8.27,95%CI 4.72～19.28,P<0.001),CT value in the arterial period(OR=7.16,95%CI 3.69～20.12,P<0.001)was an independent risk factor for PCC occurrence.(3)The prediction model of PCC was constructed based on the above risk factors,and the area under the ROC curve was 0..880(95%CI0.819～0.912).The C index of the nomogram model internally verified by Bootstrap method is 0.880,indicating that the model is more accurate than universities.Conclusion:1.In the past 10 years in our hospital,the detection rate of adrenal mass has been increasing year by year,and the adrenal non-functional adenoma accounts for the most proportion In functional tumors,PA,followed by CUS and PCC.2.In adrenal mass patients,nearly half of them were found in the form of AI,and with the improvement of imaging technology,the detection rate of AI was increased Annual increase,and better growth for those aged 60 and older.3.PA was the most common functional adrenal function tumor,and the PTH level in PA group was higher than the nonfunctional adenoma group.Meanwhile,SBP>160mm Hg,blood potassium<3.25 mmol/l,PTH≥82.5pg/ml,25(OH)D3<24.32nmol/l,and aldosterone>135.6pg/ml were independent risk factors for PA.The prediction model constructed based on the above risk factors had good predictive efficacy.4.PCC is a neuroendocrine tumor originating from the adrenal medulla.The analysis found that hypertension,triad,tumor diameter,blood epinephrine and arterial CT value are independent risk factors of PCC.The prediction model constructed based on this model has high clinical application value and can improve the prediction efficacy of this disease. |
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