The Clinical Retrospective Analsis Of138Cases Of Adrenal Incidentalomas

Objective： To improve the standard of diagnosis and treatment of adrenalincidentalomas.Method：Reviewed and analyzed a total of138cases with adrenal incidentalomaswere treated in our hospital from March2002to September2012, the diagnosis andlocation of the tumors were performed by ultrasonography, CT scaning and MRI, andthe endocrine tests, including blood free cortisol and its rhythm,renin-angiotensin-aldosterone for supine and standing position,24-hour urine17-ketonesteroid and17-hydroxy steroid,24-hour urine VMA et al. Among them,127casesreceived surgical therapy. Alpha-adrenergic receptor blocker doxazosin4mg was givenorally once per night, lasting7-10days. Blood pressure was controlled in about140/90mmHg, heart rate around90beats/min before operation. Adjust the dose according tothe fluctuations in blood pressure. If the heart rate was100beats/min or more, theaddition of beta-blockers propranolol (Inderal)10mg was given3times a day orally.Surgical therapy included adrenal-tumorectomy pass through retroperitoneal,throughenterocoelia and retroperitoneoscopic adrenal-tumorectomy.19cases were performedipsilateral adrenal total resection or subtotal resection, hydrocortisone100-200mg wasintravenously given intraoperatively and post-operatively, and additionalglucocorticoids was given as appropriate.11patients received conservative treatmentwere followed up for more than2years, CT scan of tumor was assessed every6months,and endocrinology tests every12months.Results：A total of138cases were collected, with60males,78females,72caseswith lesions in the left,62cases with lesions in the right,4cases with bilateral lesions.127patients underwent surgical treatment,21cases with open surgery,100cases withlaparoscopic surgery,6cases of which converted to open surgery.6cases were confirmed malignancy via pathology, including3cases of cortical carcinoma,2cases ofmalignant pheochromocytoma,1case of metastatic cancer.16cases were confirmedpheochromocytoma. The rest included adrenal adenoma, adrenal cyst, sectioncellsneuroma, myelolipoma benign lesions. Among6cases of malignant tumors,5caseddied in3years after operation,1case of cortical carcinoma patient has been disease-freesurvival19months. CT scans and endocrinology tests of11cases with conservativetreatment showed adrenal tumors were not significantly increased and endocrinologywas basiclly normal.Conclusions：The vast majority of adrenal incidentalomas have no obvioussymptoms, therefore fewer early clinical findings. Its diagnosis depends on imagingpositioning and detailed endocrine studies.266cases with adrenal tumors were treatedin the past10years,138cases with adrenal Incidentalomas, accounting for51.9%, withhigher prevalence than reports of literatures. Abdominal CT scan is the best choice forpositioning diagnosis, providing more clues for the judgement of malignant or benigntumors. The diagnosis could get higher specificity when CT number was set≤15HU.However, compared with the actual size of the tumor, the measured diameter of the CTis often smaller. In this study, the diameter of tumors≤3.0cm are benign, of which85.2%were cortical adenoma. Tumors whose diameter3.1-6.0cm derived from adrenalmedulla (pheochromocytoma, ganglioneuroma, medullarylipoma) and malignant tumorswas significantly increased by31.4%and11.4%, respectively. Tumors whose diameteris6cm or more is closely related (18.2%) with malignant degree. For adrenalincidentalomas were difficult to defferentiate, so surgical treatment is suggested oncethe diagnosis is confirmed, except those with advanced age and bad basic condition.Retroperitoneoscopic adrenal-tumorectomy is the best choice.