The Clinical Analysis Of Adrenal Incidentalomas

Objectives:To investigate the incidence trends,composition,and clinical diagnosis and treatment of the structure for adrenal incidentalomas.Method:Collecting data of the surgical treatment of patients with adrenal disease of Urology department in General Hospital of Tianjin Medical University from September 2003 to September 2008,Including patients with the general situation, clinical manifestations,imaging data,endocrine laboratory examination,preoperative diagnosis,surgery,pathological diagnosis and other relevant information.Adrenal incidentalomas and select patients,combined with domestic and foreign literature,its composition and incidence of clinical diagnosis and treatment trends and a comprehensive analysis of the situation.Results:(1)The incidence of adrenal incidentalomas situations:Survey was 443 cases of adrenal surgical diseases,adrenal incidentalomas for 179 cases,accounting for 40.4%,and the incidence of an upward trend in the proportion of each year.(2) Surgical treatment options:Surgery was 169 cases,with 135 cases of retroperitoneal, 3 cases of laparoscopic and open surgery in 31 cases.125 cases in which resection of the affected tumors and adrenal tissue,40 cases of simple removal of the tumor,4 cases of vascular tumor or organ with an important line only exploratory surgery adhesions.(3) Pathology Results:pheochromocytoma in 23 cases,72 cases of cortical adenoma,primary aldosteronism in 17 cases,5 cases of Cushing syndrome, three cases of adrenocortical carcinoma,3 cases of metastatic carcinoma,11 cases of adrenal cysts,myeloid 19 cases of lipoma,Ganglioneuroma eight cases,seven cases of nodular hyperplasia,adrenal hemorrhage in 1 case.3 cases of metastatic carcinoma in two cases of lung metastasis,1 case of gastric cancer metastasis.(4) follow-up: The set of data on 11 cases of patients with follow-up observation,consider the 6 cases in which cortical tumors,the diameter of less than 3cm,non-functional performance,endocrine examination no abnormalities;diagnosed 3 cases of adrenal cyst diameter less than 4cm;1 case of adrenal myelolipoma diameter less than 4cm, the patients were reviewed every 6 months time,no significant increase volume, endocrine examination no significant change.1 case in which the incidence of tumor diameter of 2cm,1 years after the review is greater than the diameter of 3cm,a heavier psychological burden as a result of patients,after laparoscopic surgery, postoperative pathology report as adrenal ganglioneuroma.Conclusion:With the physical examination and imaging of the rapid development of adrenal incidentalomas showed the detection rate rising.Through this set of data adrenal incidentalomas statistics constitute the majority of benign tumors,accounting for 96.7%;rare malignant tumor accounting for 3.3%.Functional tumors accounted for 42.5%,non-functioning tumors accounted for 57.5%.Adrenocortical adenoma highest incidence.Adrenal myelolipoma,adrenal cyst,adrenal hemorrhage CT diagnosis and pathological diagnosis consistent with the rate of 100%,CT can be used as the qualitative diagnosis of the diagnosis.The rest of the tumor to be based on pathology many adrenal incidentalomas are benign non-functioning tumors. Through the endocrine function tests,to determine whether sub-clinical adrenal hormone secretion,an increase in critical.An accurate grasp of surgical indications should be needed in the treatment of adrenal incidentalomas.At present,surgery is a relatively accepted principle:the endocrine activity of tumors and malignant tendency. In our opinion,subclinical adrenal hormones increase and static pheochromocytoma also should be taken to surgery.With the development of the majority of laparoscopic adrenal incidentalomas through laparoscopic surgery or after laparoscopic resection for suspected malignant tumors greater than 6cm and adhesion with the surrounding organs in order to open surgery is appropriate.Have a clear diagnosis of less than 5cm adrenal cyst and myelolipoma 3cm or less than the non-endocrine adrenocortical adenoma follow-up could be considered in the follow-up short-term course of rapid growth such as tumors or adrenal hormone secretion,showing signs of increase surgical treatment should be...