Diagnosis And Treatment Of Adrenal Incidentaloma

Objective: To summarize the diagnosis and treatment of adrenal incidental tumors,provide better treatment for patients,and analyze the relationship between benign and malignant adrenal incidental tumors and tumor diameter.Method: A retrospective analysis was made of the diagnosis and treatment data of 94 patients admitted to the Department of Urology and Surgery of the First Hospital of Jilin University from January 1,2017 to December 31,2018,who met the definition of adrenal incidental tumors.The clinical characteristics of specific pathological types of adrenal incidental tumors were summarized.The value of adrenaline hormone examination and imaging examination in the diagnosis of adrenal incidentaloma and the relationship between the diameter of tumors and the benign and malignant tumors were analyzed.Result: 94 subjects were enrolled in this group,including 33 males and 61 females,aged 22-76 years,with a median age of 48 years.The ratio of males to females was 1:1.85,and the majority of them were 55-60 years old.All patients had no symptoms such as centripetal obesity,paroxysmal headache,palpitation,sweating or limb numbness.A total of 31 cases of adrenal incidentaloma were found by physical examination,24 cases by lumbar and abdominal discomfort examination,and 39 cases by other diseases examination by chance.There were 40 cases with lesions on the left side,47 cases on the right side and 7 cases on both sides.Among the subjects,94 cases underwent CT plain scan and phase II enhancement,all of which showed lesions;9 cases underwent color doppler ultrasonography,of which 1 case had no lesions and the rest had lesions;2 cases underwent MRI,all of which had lesions.Ninety-four patients in this group were admitted to hospital for complete biochemical and hormonal examinations.Among them,73 cases were diagnosed as non-functional adrenal incidentaloma before operation,8 cases were diagnosed as PHA,spironolactone and intravenous potassium supplementation were given before operation until the blood potassium returned to normal level;There were 3 cases of PHEO,which were treated with phenoxybenzamine and dilatation before operation;There were 10 cases of SCS,Patients were given hormone therapy before and after operation.Laparoscopic surgery was used in all the subjects without open surgery.According to individual differences of patients,the patients were divided into three approaches: lateral approach,transperitoneal approach and posterior approach.76 cases(80.9%)had lateral approach,the average diameter of tumors was 2.48 cm,13 cases(13.8%)had transperitoneal approach,the average diameter of tumors was 5.12 cm,5 cases(5.3%)had posterior approach,and the diameter of tumors was 5 cm.Surgical specimens were obtained after operation.The diameter of tumors ranged from 1.1 cm to 12 cm,and 83 benign tumors ranged from 1.1 cm to 12 cm,with a median of 2.50 cm.The diameter of malignant tumors ranged from 2 to 6 cm,with a median of 4.80 cm.Among benign tumors,89.2% had a diameter of less than 4 cm and 10.8% had a diameter of more than 4 cm.Among malignant tumors,54.5% had a diameter of less than 4 cm and 45.5% had a diameter of more than 4 cm(?2=9.179,P=0.002).The malignant degree of tumors with diameter > 4cm increased,which was statistically significant(P < 0.005)by Chi-square test.The ROC curve shows that the area under the curve(AUC)is 0.705,the maximum Youden index is 0.391,the corresponding critical diameter is 2.45 cm,the sensitivity is 90.9%,and the specificity is 48.2%.When the diameter of the tumors was 4 cm,the sensitivity and specificity were 45.5% and 89.2% respectively.Postoperative pathology included 59 cases of cortical adenoma,7 cases of pheochromocytoma,26 cases of other benign lesions,1 case of metastasis and 1 case of other malignant lesions.Conclusion: 1.According to the diameter of incidental adrenal tumors,the benign and malignant tumors can be preliminarily judged.2.For the diagnosis of adrenal incidental tumors,CT + phase II enhancement is the first choice.