目的:偶发肾上腺肿块很常见,需要采用多学科方法进行评估和管理,包括家庭医生,泌尿科医师,内分泌学家,和放射科医生。本指南的目的是提供一种更新的诊断方法,管理,和肾上腺偶发瘤的随访,特别关注其他协会发布的指南中存在的差异/争议领域。
方法:本指南由加拿大泌尿外科协会(CUA)通过一个由泌尿科医师组成的工作组制定,内分泌学家,和放射科医师,随后得到美国泌尿外科协会(AUA)的认可。利用GRADE方法的系统审查是基于证据的建议的基础,在没有证据的情况下提供共识声明。对于每个准则声明,据报道,推荐力度弱或强,证据质量被评估为低,中等或高。
结果:CUA工作组根据最新的系统评价和主题专业知识提供了基于证据和共识的建议。建议中包含了基于证据的放射学评估和激素测试的重要更新。该指南阐明了哪些患者可能从手术中受益,并强调了短期监测的适当位置。
结论:顺便说一句,发现肾上腺肿块需要对激素功能和肿瘤风险进行全面评估。本指南为适当的临床提供了一种当代方法,射线照相,以及评估所需的内分泌评估,管理,并对患有此类病变的患者进行随访。
Incidental adrenal masses are common and require a multidisciplinary approach to evaluation and management that includes family physicians, urologists, endocrinologists, and radiologists. The purpose of this guideline is to provide an updated approach to the diagnosis, management, and follow-up of adrenal incidentalomas, with a special focus on the areas of discrepancy/controversy existing among the published guidelines from other associations.
This guideline was developed by the Canadian Urological Association (CUA) through a working group comprised of urologists, endocrinologists, and radiologists and subsequently endorsed by the American Urological Association (AUA). A systematic review utilizing the GRADE approach served as the basis for evidence-based recommendations with consensus statements provided in the absence of evidence. For each guideline statement, the strength of recommendation was reported as weak or strong, and the quality of evidence was evaluated as low, medium, or high.
The CUA working group provided evidence- and consensus-based recommendations based on an updated systematic review and subject matter expertise. Important updates on evidence-based radiological evaluation and hormonal testing are included in the recommendations. This guideline clarifies which patients may benefit from surgery and highlights where short term surveillance is appropriate.
Incidentally detected adrenal masses require a comprehensive assessment of hormonal function and oncologic risk. This guideline provides a contemporary approach to the appropriate clinical, radiographic, and endocrine assessments required for the evaluation, management, and follow-up of patients with such lesions.