Clinical Analysis Of Eighty-Four Cases Of Adrenal Incidentalomas

Background: Adrenal incidentalomas(AI) refers to adrenal diseases discovered by accident when people do physical examination or imaging has no relationship with adrenal tumors. In recent years, because of physical examination and imaging technology develop quickly, the detection rate of adrenal incidentalomas increases. Diagnosis of adrenal diseases rely on clinical manifestations, laboratory tests and imaging aspects, owing to lacking of a typical clinical manifestation of AI, the clinical standards of diagnosis and treatment has always been a debate. Also is a difficult problem. Objective: Summarized clinical characteristics of specific pathological type of adrenal incidentalomas, analysing the value of adrenal endocrine examination and imaging in the diagnosis of AI. And explore clinical efficacy and safety of retroperitoneal laparoscopic adrenal adenoma resection in the treatment of adrenal adenoma, in order to improve the level of diagnosis and treatment for AI.Material and method: Reviewed the clinical data of 84 cases of patients who having surgical treatment of adrenal incidentalomas in 2013-2016 in General Hospital of Tianjin Medical University, including 34 cases of male patients and 50 cases of female patients. According to the exact pathology after operation, all the patients were divided into two groups, either benign or malignant AI group,by using means of two independent samples T inspection statistical methods,the difference between tumor diameter and tumor whether benign or malignant were tested. In order to distinguish the efficiency of imaging examination in the diagnosis of AI, respectively ultrasound, CT, MRI examination of patients with AI. Its location efficiency using of Chi-square test. And a comparison of imaging diagnosis efficacy in preoperative diagnosis of AI and pathological diagnosis. Further clarify the clinical value of imaging examination. also analyzed the role of Adrenal endocrine examination in diagnosis of AI. Result: our research include 84 cases of AI patients in all, all patients have surgery treatment. according to pathology results,we divided patients into benign AI including(adenoma, and cyst, and Adrenal cortex knot hyperplasia, and big knot hyperplasia, and Adrenal Medulla Lipoma, and fat tumor, and the adrenal nerve cells tumor, and lymphatic tumor,) and malignant AI(including transfer cancer, and cortex gland carsinoma, and Sarcoma sample cancer, and PHEO). the number of benign AI cases is 74, average tumor diameter is 2.38 cm, Standard deviation is 0.96, malignant AI is 6 cases totally, average tumor diameter is 5.34 cm, Standard deviation is 1.54,P value is 0.005(obviously less than 0.05). 82 cases have ultrasound inspect, of which 66 cases of patients with preoperative locational diagnosis, diagnostic effectiveness is 80.48%. CT, MRI examination in patients respectively with 84 and 30, the diagnosis and effective are both 100%. Campare ultrasound and CT efficient in diagnosis of AI, P value is 0.018.Comparison of CT and MRI, P value is 0.561. Comparison of ultrasound and MRI,P value is 0.035. B-ultrasound, CT and MRI in the same preoperative diagnosis of adrenal cortical adenoma associating with Pathologic diagnosis, respectively, and 84.3%, and 88.2%. No significant statistical difference. CT examination of preoperative diagnosis for adrenal cyst and adrenal Medulla Lipoma, the diagnosis rate 100%. Showed that CT for preoperative diagnosis of this 3 pathology. Conclusion: 1.the correlation between tumor diameter and benign or malignant AI is exist, malignant AI tumor diameter are usually larger than 5cm. 2, ultrasound and CT, MRI examination in local diagnosis of AI exist significant differences, the localization rate of the latter is better than the former, CT and MRI in preoperative local diagnosis of AI have no significant differences. 3, CT, and MRI have higher diagnosis rates for adrenal cyst and adrenal Medulla Lipoma, adrenal Lipoma, there was no significant difference between CT and MRI.4, nonfunctioning adenoma is the most common form in Adrenal incidentalomas, functional adrenal incidentalomas primary aldosteronism is the most common form in functional adrenal incidentalomas, followed by Cushing's syndrome, rare is pheochromocytoma.5,with a AI diameter lager than 3cm of patients with adrenal incidentalomas, retroperitoneal laparoscopic adrenal tumor resection is the treatment of first choice, AI diameter less than or equal to 3cm and have no adrenal gland endocrine function, requires a combination of patient age, medical history, imaging to considering whether surgical treatment.6, Retroperitoneal laparoscopic adrenal tumor resection is the first choice for AI treatments.