【优秀文档】肾上腺意外瘤指南PPT.pptVIP

肾上腺意外瘤指南 OutlineDefinitionPrevalenceAnatomy and Physiology ReviewDiagnostic WorkupsConclusions 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.”Management of the clinically inapparent adrenal mass (incidentaloma). NIH State-of-the-Science Conference Statement Feb 4-6, 2002. PrevalenceAutopsies: 87,065 cases: 6% with adrenal adenomasAbdominal CT (61,054 CT scans reviewed): 4% with adrenal adenomasNow approaches the 8.7% incidence reported in autopsy series Incidence Increases with AgeEndocrine and Metabolism Clinics of North America . 2000; 29(1):159-185 Three Main QuestionsIs the adrenal mass hormonally active?Is the mass benign or malignant?Does the patient have a history of a previous malignant lesion? Is it metastatic? Anatomy Anatomy AnatomyPrimary AldosteronismCushing’s SyndromeDHEA-sPheochromocytoma Frequency of FindingsMulticenter study of 1096 casesNonfunctioning adenoma: 85%Subclinical Cushing’s syndrome: 9%Pheochromocytoma: 4%Aldosteronomas: 2%Mantero et al. 85 (2): 637. (2000) Frequency of FindingsAllolio, B., Adrenal Incidentalomas.Adrenal Disorders, ed. C.G. Margioris AN. 2001, Totowa: Humana Press Inc. A summary of the literatureNonfunctioning 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 Does the patient have a history of a previous malignant lesion?Weakness, crampsAnatomy and Physiology ReviewMontwill J, et al.Typically occur in the presence of clinical manifestations (hirsutism or virilization)Three Main QuestionsDisagreement!Incidentally discovered adrenal tumors: an institutional perspective.Most common primaryTypically occur in the presence of clinical manifestations (hirsutism or virilization)Imaging- metastasesDoes the patient have a history of