| ObjectiveWe report our patients from a single institute and analyze the clinical parameters in352patients with adrenal diseases. We retrospectively analyzed the clinical characteristics of elderly patients with Common adrenal disease, explore the diagnosis and treatment of elderly patients with adrenal disease.MethodBetween January2001and September2011, we performed352patients at Tianjin Medical University General Hospital. All age form21to81years old(average40.45years old).Patients were grouped by three groups according to the age:youth (20-44yrs), middle-age (45-59yrs) and elder group (>60yrs). Male to female was161:191, left171, right165, beside16(Only accept one surgery or conservative treatment). A retrospective cohort study of prospectively collected data was conducted. Compared the distribution, frequency and types of different age groups of patient of adrenal tumor, and studied the distribution of the disease, the clinical symptoms and biochemical test results, tumor size, treatment and the effect of differences in each group.ResultsIn total,271cases of functional adenoma in352patients;81case with non-functioning adenomas.352patients underwent321adrenalectomies (Including laparoscopic249, open72);31case choose conservative treatment.l.(l)Non-functioning adenomas in the group of elderly patients (35cases,52.24%) were higher than that in middle-aged group(21cases,16.03%) and in youth group(25cases,16.23%),(P<0.05).(2)Adrenal incidentalomas in the group of elderly patients (26cases,38.81%) were higher than that in the other two groups (20cases,15.27%:12cases,7.79%, respectively),(P<0.05). 2.(1) Patients with Cushing’s syndrome and primary aldosteronism test results showed close.(2) VMA was on a downward trend with age.The patients of pheochromocytoma with high24h urine vanilla mandelic acid (VMA) levels in elderly patients (45.45%) were less than that in the other two groups(81.58%,83.67%, respectively),(P<0.05).(3) Three groups of patients according to laboratory tests to make the initial diagnosis and final pathological diagnosis accuracy rate in the group of elderly patients(87.5%) were approach to that in the other two groups (86.87%,91.21%, respectively),and no statistical difference (P>0.05).3.(1) Imaging prompted that adrenal hyperplasia lesions in the group of elderly patients (21cases,31.34%) were higher than that in the other two groups (26cases,19.85%:14cases,9.4%, respectively),showed an increase in the proportion of adrenalopathy with age.(2) The tumors of the three age groups had no significant differences in location,the size of tumor roughly equaled.4.(1) Treatment based on surgery.352patients underwent321(91.2%) adrenalectomies,Including laparoscopic249(77.57%), open72(22.43%)(2)Compared to other two groups(5.34%,6.49%, respectively), those in the elderly(20.9%) group were more likely to choose conservative treatment,(P<0.05).(3)In the surgical treatment of patients, undergoing total adrenalectomy in the group of elderly patients (27cases,50.94%) were higher than that in the other two groups(38cases,30.65%;42cases,29.17%, respectively),(P<0.05).5. Similar to three groups of perioperative period.The average operation time were109.7min,113.6min and126.5min in the in the group of elderly patients, middle-aged group and youth group, respectively. The bloodloss during operation was31.4ml,43.5ml, and36.2ml, respectively.Postoperative hospitalization was10.6days,9.6days, and9.8days, respectively.6. In preoperative patients with high blood pressure, Postoperative blood pressure returned to normal in elderly patients (15cases,60%) were less than that in the other two groups(87cases,86.14%;105cases,91.31%, respectively),(P<0.05). The proportion of patients who needed antihypertensive drug at postsurgery increased in elderly group.Conclusions1. Non-functioning adenomas in the group of elderly patients (52.24%) were higher than other2groups. More incidentalomas without clinical symptoms in old age group and Initial diagnosis rely more on imaging and laboratory tests.2. Because the level of24h urinary VMA on a downward trend in Old age group, so suspected for elderly patients with pheochromocytoma should consider a combination of symptoms and imaging performance.Other laboratory parameters level approximation.Elderly patients with standard laboratory tests can use other types of common adrenal disease diagnosis.3. Tumor size and orientation distribution of the three groups were closed.Elderly patients with adrenal disease was show the high proportion of diffuse hyperplasia lesions.4. A high proportion of elderly patients with conservative treatment.Adrenal resection accounted for a large proportion.5. Low proportion of elderly patients returned to normal. Elderly patients should insist on monitoring of blood pressure and use of antihypertensive medication.6. Principles of treatment of adrenal disease in elderly patients should be read in conjunction with the specific conditions of individual treatment. |
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