目的:评估临床和影像学特征是否可以预测激素亚型,增长,和肾上腺切除术治疗偶发性肾上腺皮质腺瘤(ACA)。
方法:单中心队列研究。
方法:2000年至2016年连续诊断为偶发ACA的成年患者。
结果:在1516例附带ACA患者中(中位年龄59岁,62%的女性),699(46%)患有无功能腺瘤(NFA),482例(31%)有轻度自主皮质醇分泌(MACS),62(4%)患有原发性醛固酮增多症(PA),39人(3%)患有库欣综合征(CS),18(1%)患有PA和MACS(PA-MACS),和226(15%)有不完整的检查。年龄,性别,肿瘤大小,和肿瘤侧向性,但不是未增强的计算机断层扫描Hounsfield单位(HU),与荷尔蒙亚型有关。在多变量分析中,≥1cm的增长与年龄较小相关(每5年增长的比值比,OR=0.8,P=0.0047)和更长的影像学随访(OR=1.2/年,P<.0001)。355例(23%)患者进行了肾上腺切除术,包括38%的MACS和15%的NFA。NFA和MACS的肾上腺切除术在年轻患者中更为常见(OR=0.79/5年增加,P=0.002),较大的初始肿瘤大小(OR=2.3每增加1厘米,P<.0001),生长≥1cm(OR=15.3,P<0.0001),和较高的后地塞米松皮质醇(OR=6.6>5vs<1.8mcg/dL,P=0.002)。
结论:年龄,性别,肿瘤大小,和侧向性与ACA激素亚型相关,可指导诊断和治疗.随着年龄的增长和随访时间的延长,肿瘤的生长更为常见。未增强的HU不能预测激素亚型或生长。MACS和NFA的肾上腺切除术主要在肿瘤较大的年轻患者中进行,增长,地塞米松后皮质醇升高。
OBJECTIVE: The aim of this
study is to assess whether clinical and imaging characteristics are associated with the hormonal subtype, growth, and adrenalectomy for incidental adrenal cortical adenomas (ACAs).
METHODS: This is a single-center cohort
study.
METHODS: Consecutive adult patients with incidental ACA were diagnosed between 2000 and 2016.
RESULTS: Of the 1516 patients with incidental ACA (median age 59 years, 62% women), 699 (46%) had nonfunctioning adenomas (NFAs), 482 (31%) had mild autonomous cortisol secretion (MACS), 62 (4%) had primary aldosteronism (PA), 39 (3%) had Cushing syndrome, 18 (1%) had PA and MACS, and 226 (15%) had incomplete work-up. Age, sex, tumor size, and tumor laterality, but not unenhanced computed tomography Hounsfield units (HU), were associated with hormonal subtypes. In a multivariable analysis, ≥1 cm growth was associated with younger age (odds ratio [OR] = 0.8 per 5-year increase, P = .0047) and longer imaging follow-up (OR = 1.2 per year, P < .0001). Adrenalectomy was performed in 355 (23%) patients, including 38% of MACS and 15% of NFA. Adrenalectomy for NFA and MACS was more common in younger patients (OR = 0.79 per 5-year increase, P = .002), larger initial tumor size (OR = 2.3 per 1 cm increase, P < .0001), ≥1 cm growth (OR = 15.3, P < .0001), and higher postdexamethasone cortisol (OR = 6.6 for >5 vs <1.8 μg/dL, P = .002).
CONCLUSIONS: Age, sex, tumor size, and laterality were associated with ACA hormonal subtype and can guide diagnosis and management. Tumor growth was more common with younger age and longer follow-up. Unenhanced HU did not predict hormonal subtype or growth. Adrenalectomy for MACS and NFA was mainly performed in younger patients with larger tumor size, growth, and elevated postdexamethasone cortisol.