| Objective To strengthen understanding of adrenal incidentaloma(AI),and investigate the main diagnostic and therapeutic points of adrenal incidentaloma,in order to provide the reference for diagnosis and treatment of adrenal incidentaloma.Methods A retrospective study was performed to analyze the clinical data for 151 cases with adrenal incidentaloma who underwent surgical treatment during Jan.2020 and Dec.2021 from Department of Urology,Shandong Province Hospital.Also,a discussion combined with recent literature of these results was performed.Results 1.Baseline characteristics:151 cases were brought into this study with a mean age of(53.57±11.54)years old,including 78(51.7%)males and 73(48.3%)females,of which 77(51.0%)had hypertension.The clinical symptoms were showed in 52 cases(34.4%).2.Causes of first diagnosis:Physical examination,that had 85 cases(56.3%),was the first cause;9 cases discovered because of abdominal discomfort were in the second place.3.Endocrinological inspections:There were 88 cases(58.3%)of all the AI without secretory function,and 45 cases(29.8%)with primary hyperaldosteronism,which made up the largest part of the functional tumors.4.1maging examination:There were 16 cases(10.6%)with tumors on the both sides,76 cases(50.3%)on the left side,and 59 cases(39.1%)on the right side.The diameter of adrenal incidentalomas was between 1.0cm and 14.7cm,with an average diameter of(3.41±2.58)cm.5.Operative condition:7 cases with adrenal incidentaloma were surgically removed within open approach,and 145 cases(95.4%)were treated through laparoscopic adrenalectomy,among which 75 adrenalectomy were performed through transperitoneal approach,and 70 adrenalectomy were performed through retroperitoneal approach.There were 152 cases underwent surgical operation,among them adrenalectomy performed in 57 cases(37.5%)and partial adrenalectomy performed in 95 cases(62.5%).6.Postoperativepathology:postoperative pathology finally diagnosed adrenocortical adenoma in 100 cases(65.8%),adrenal pheochromocytoma in 18 cases(11.8%),adrenocortical carcinoma in 2 cases(1.3%)and metastatic tumor in 3 cases(2.0%).The receiver operating characteristic(ROC)cure of relationship between the diameter and benign or malignant tumors was built.The area under the ROC cure was 0.730(95%confidence interval[CI]0.569～0.892,P=0.04),explaining that the diameter of tumors had medium ability for differentiating benign tumors from malignant ones.The maximum Youden index was 0.547,leading to the best cut-off point:3.35cm for the diameter of tumors.Its sensitivity and specificity were 85.7%and 69.0%,respectively.Conclusion 1.Most of adrenal incidentalomas are benign and discovered in physical examination,while a small part of the all may be functional and malignant;Each adrenal incidentaloma must be evaluated whether it has secretory function,while most of them are nonfunctional.2.The diagnostic ability of computed tomography(CT)and magnetic resonance imaging(MRI)is approximate and both excellent,although the performance of B-mode ultrasound,which is appropriate for monitoring the development and change of benign adrenal incidentalomas,is a little poorer than theirs.3.When the diameter of tumors is less than 3.35cm,the benign non-functioning tumors may choose to observe and periodic review of a conservative;for the diameter of tumors greater than 3.35cm,suspicious malignant tumors or functional tumors,surgical treatment should be taken as early as possible. |
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