肾上腺意外瘤指南培训课件

肾上腺意外瘤指南
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Incidence Increases with Age
Patient(%)
8 6 4 2 0
0~9 10~19 20~29 30~39 40~49 50~59 60~69 >70 Age(y)
Endocrine and Metabolism Clinics of North America . 2000; 29(1):159-185
肾上腺意外瘤指南
*Reimage in 3 to 6
months and annually for 1 to 2 years; repeat functional studies annually for 5 years.If mass grows more than 1cm or becomes hormonally active, then adrenalectomy is recommended.
❖ Autopsies: 87,065 cases: 6% with adrenal adenomas
❖ Abdominal CT (61,054 CT scans reviewed): 4% with adrenal adenomas
❖ Now approaches the 8.7% incidence reported in autopsy series
❖ 肾上腺皮质癌的患者手术前需要外科医师和内分泌科医师或 肿瘤科医师共同协商决定切除的方式，因为首次切除的效果 是生存率的主要预测因素。
❖ 超过4cm的肾上腺无功能瘤可以考虑切除。小的髓脂肪瘤或 良性的囊肿一般影像学检查即可确诊，通常不需要治疗，除 非有症状可以考虑手术治疗。
肾上腺意外瘤指南
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Algorithm for the evaluation and management of an adrenal incidentaloma
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Anatomy
肾上腺意外瘤指南
Primary Aldosteronism
Cushing’s Syndrome
DHEA-s Pheochromocytoma
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Frequency of Findings
❖ Multicenter study of 1096 cases
Nonfunctioning adenoma: 85% Subclinical Cushing’s syndrome: 9% Pheochromocytoma: 4% Aldosteronomas: 2%
肾上腺意外瘤指南
Outline
❖ Definition ❖ Prevalence ❖ Anatomy and Physiology Review ❖ Diagnostic Workups ❖ Conclusions
肾上腺意外瘤指南
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Definition
❖ “Mass lesion greater than 1 cm in diameter discovered “accidentally” during a radiographic examination performed for indications other than an evaluation for adrenal disease.”
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A summary of the literature
❖ Nonfunctioning adenoma Approximately 80% ❖ Subclinical Cushing syndrome (SCS), 5% ❖ Pheochromocytoma 5% ❖ Aldosteronoma 1% ❖ adrenocortical carcinoma (ACC) <5 % ❖ Metastatic lesion 2.5% ❖ Ganglioneuromas, myelolipomas,or benign cysts
Mantero et al. 85 (2): 637. (2000)
肾上腺意外瘤指南
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Frequency of Findings
Allolio, B., Adrenal Incidentalomas.
Adrenal Disorders, ed. C.G. Margioris AN. 2001, T肾oto上w腺a:意H外um瘤a指na南Press Inc.
肾上腺意外瘤指南
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Three Main Questions
❖ Is the adrenal mass hormonally active? ❖ Is the mass benign or malignant? ❖ Does the patient have a history of a
previous malignant lesion?
肾上腺意外瘤指南
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考虑是否手术治疗之前准确的功能诊 断非常必要
❖ 嗜铬细胞瘤要进行认真的术前准备以避免术中和术后的发作 和死亡。
❖ 原发性醛固酮增多症的患者需要明确是否存在肾上腺皮质增 生及无功能的肾上腺腺瘤。肾上腺源性Cushing综合征的患 者在行切除术后可能发生肾上腺皮质功能不全，激素的替代 以及增减治疗需要非常仔细。亚临床Cushing综合征的患者 是否需要手术治疗仍存在争议。
Management of the clinically inapparent adrenal mass (incidentaloma). NIH State-of-the-Science Conference Statement Feb 4-6, 2002.
肾上腺意外瘤指南
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Prevalence
Is it metastatic?
肾上腺意外瘤指南
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Anatomy
http://shutterbug.ucsc.edu/sealion/view_photo.php?set肾_a上lb腺um意N外am瘤e指=a南lbum265&id=Adrenal
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ห้องสมุดไป่ตู้
Anatomy
http://shutterbug.ucsc.edu/sealion/view_photo.php?set肾_a上lb腺um意N外am瘤e指=a南lbum265&id=Adrenal