| ObjectivesTo summarize the clinical features of adrenal gland space-occupying lesions,discuss their diagnosis method and treatment development,to improve the diagnostic level of internal medicine in the adrenal gland space-occupying lesions.Objects and MethodsWe took the cases of adrenal gland space-occupying lesions diagnosed by Department of Endocrinology in Shandong Provincial Hospital from January 2006 to December 2015 as our study objects.According to the inclusion criteria,a total of 66 patients were included in the study.Retrospective analysis was used in the study.The patients’ clinical case data was consulted and extracted according to the prior form,such as image examination results(color doppler ultrasound,computed tomography or magnetic resonance imaging,etc.),endocrine examination results(free cortisol of blood and its rhythm,renin-angiotensin-aldosterone in supine and erect position,24 hour vanilmandelic acid,etc.).The prognosis of patients with conservative treatment and operation treatment was observed,in order to explore the different therapeutic effects of adrenal gland space-occupying lesions.Results1.General information:A total of 66 patients were included in the study after selection,among them,28 cases were male(42.4%),38 cases were female(57.6%),and male:female =1:1.36.The average age was 47.68±13.80.20 cases received surgical treatment(30.3%)and 46 cases received conservative treatment(69.7%).The costs were 1799-27294 yuan(7466.62±5429.85)and average length of hospital stay was 9.09±5.58 days.2.Clinical types:Among all these cases,25 cases were simple adenoma(37.9%),14 cases were Cushing’s syndrome(21.2%),12 cases were primary aldosteronism(18.2%),5 cases were not clearly diagnosed(7.6%),5 cases were cortical nodular hyperplasia(7.6%),2 cases were pheochromocytoma(3.0%),2 cases were adrenocortical carcinoma(3.0%),1 case was ganglion cells neuroma(1.5%).3.Gender differences:The clinical types of patients were different in patients of different genders,and the number of female patients with Cushing’s syndrome was larger than that of male patients(P=0.006).And male patients were more prone to have electrolyte disorder(P=0.027).4.The differences of age groups:The gender distribution of each age group was different,the majority of young and middle-aged group were women while the majority of elderly group were male(P=0.04).There was no significant difference in the history of hypertension between different age groups,indicating that the history of hypertension in patients with adrenal occupying lesions was not related to age.5.Clinical manifestation:The clinical manifestations of patients were various.Hypertension and hypokalemia were the critical manifestations.29 cases had electrolyte disorder(43.9%),among them,26 cases were hypokalemia(39.4%),and the others were hyponatremia and hypocalcaemia.Main clinical manifestations:24 cases of hypertension(36.4%),13 cases of limbs weakness(19.7%),7 cases of headache(10.6%),7 cases of edema(10.6%),3 cases of polydipsia polyuria(4.5%),3 cases of weight gaining(4.5%),2 cases of hypoglycemia(3.0%)and 7 cases were found by physical examination(10.6%).6.Biochemical test:(1)Blood free cortisol and circadian rhythm was tested in all cases.The detection sensitivity was 92.86%and the detection specificity was 71.15%for Cushing’s syndrome.(2)Renin-angiotensin-aldosterone in supine and erect position was tested in all cases.The detection sensitivity was 58.33%and the specificity was 79.63%for primary aldosteronism.(3)Aldosterone/renin was tested in all cases.The detection sensitivity was 66.67%and the specificity was 92.59%for primary aldosteronism.(4)24 hour urine VMA was tested in 3 cases(4.55%).(5)Catecholaminea in blood and urine was tested in 3 cases(4.55%).The diagnosis rate for pheochromocytoma was 50%.(6)Low dose of dexamethasone suppression test was tested in 14 cases(21.21%).The detection sensitivity was 100%and the specificity was 66.67%for Cushing’s syndrome.(7)High dose of dexamethasone suppression test was tested in 12 cases(18.20%).(8)Captopril trial was tested in 6 cases(9.1%)and the diagnosis rate for primary aldosteronism was 50%.7.Imaging examination:(1)Ultrasonography was performed in 9 cases(13.6%)and the diagnostic rate was 77.8%.(2)Computed tomography scan was performed in 57 cases(86.4%)and the diagnostic rate was 94.7%.(3)Magnetic resonance imaging was performed in 8 cases(12.1%)and the diagnostic rate was 100%.8.Space-occupying lesions:Lesions located on the left side were 39 cases(59.1%),on the right side were 21 cases(31.8%)and on both sides were 6 cases(9.1%).59 cases were single lesion(89.4%)while 7 cases were multiple lesions(10.6%).Occupying lesions were mostly adenomas,a total of 46 cases,accounting for 69.7%,among which 10 cases were adenoma sebaceum,accounting for 15.2%of the total number of cases.The followings were cortical adenoma and nodular hyperplasia in 6 cases(9.1%),cortical nodular hyperplasia in 5 cases(7.6%),not clearly diagnosed in 4 cases(6.1%),pheochromocytoma in 2 cases(3.0%),primary malignant tumor in 2 cases(3.0%),ganglion cells neuroma in 1 case(1.5%).9.Operation situations:20 patients received operations,all laparoscopic surgery.17 cases were performed adrenal gland resection of the affected side and 3 cases were performed adrenal tumor resection of the affected side.The surgery time was 30-300 minutes.The median amount of intraoperative blood loss was 30 ml and the mean postoperative drainage tube indwelling time was 5.70±1.56 days.The mean postoperative hospital stay was 11.70±7.88 days and the costs were 1799-29274 yuan(7905.35±6594.76).10.Operation and conservative treatment group:There was no significant difference between the two groups in terms of gender,initial symptoms and clinical types.There was also no significant difference in the diameter of the space-occupying lesions between the 2 groups(Z=-1.43,P=0.152).11.Pathological results:20 cases were diagnosed with a definite pathological diagnosis(30.3%)and 19 cases were in accordance with the clinical diagnosis,accounting for 95.0%of cases with definite diagnosis.Only 1 case had the immunohistochemical examination:a-inhibin(+)syn(+)cga(-)s-100(-)ki-67 3%.12.Prognosis results:Of all the cases enrolled in this study,57 patients were paid a return visit.The loss rate was 13.6%.Main clinical symptoms improved significantly after treatment in 32 cases,56.1%of the followed-up cases;symptoms slightly improved in 22 cases,38.6%of the followed-up cases;no improve in 3 cases,5.3%of the followed-up cases.26 cases had the regular endocrinology inspectors,test results were normal in 18 cases,abnormal in 8 cases.The operation group had a better prognosis than the conservative treatment group.Conclusions1.Hypertension and hypokalemia are common manifestations in patients with adrenal gland space-occupying lesions.Simple adenoma,Cushing’s syndrome,primary aldosteronism and pheochromocytoma are all often seen in patients with adrenal gland space-occupying lesions.2.In the imaging examination for location diagnosis,computed tomography scan has been used mostly widely and magnetic resonance imaging has a high sensitivity performance.3.Adrenal adenoma accounts for the biggest proportion in postoperative pathological results,which often occurs on one side and is single.4.Laparoscopic surgery is the main method for the treatment of benign adrenal tumors while the conservative treatment is the main means for those whose manifestation is not so obvious or whose situation isn’t suit for operation. |
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