Many Faces of Adrenal Lesions in a Large Patient Cohort: What Has Changed Over the Last Two Decades?

IF 1.6 4区 医学 Q4 ENDOCRINOLOGY & METABOLISM Experimental and Clinical Endocrinology & Diabetes Pub Date : 2023-04-01 DOI:10.1055/a-2035-6091
Basak Ozgen Saydam, Mustafa Baris, Suleyman Cem Adiyaman, Tevfik Demir, Mehmet Ali Kocdor, Omer Demir, Mustafa Secil, Serkan Yener
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Abstract

Objective: To review the presentation characteristics, clinical and hormonal evaluations, and histopathological results of patients with adrenal lesions over a 21-year period and evaluate the changes across the two decades.

Methods: This single-center, retrospective study included 1003 patients with adrenal lesions who presented to our department between 2000 and 2021. Clinical, metabolic, hormonal, radiological, and pathological data of the patients were collected.

Results: Forty-seven percent of the lesions were non-functioning adrenal adenomas. Possible autonomous and autonomous cortisol secretion were detected in 22.2% of the patients. The percentages of the patients diagnosed with pheochromocytoma, primary hyperaldosteronism, adrenal Cushing syndrome, adrenocortical carcinoma, and adrenal metastasis were 7.4%, 4.8%, 4.7%, 0.9%, and 5.6%, respectively. Adrenalectomy was performed in 31.3% of the patients. Functional adrenal lesions were the leading cause of surgery (46.5%), followed by large size and/or suspicious imaging features (38.6%). Among the patients referred to surgery due to large size (≥6 cm), the diagnosis in 19% was metastasis, and in 12.1%, it was primary adrenocortical carcinoma. In patients with adrenal lesions with a size of 4-6 cm and suspicious imaging properties, the rates of metastasis and primary adrenocortical carcinoma were 44.4% and 4.8%, respectively. From the first to the second decade, major differences in presentation characteristics were increased detection of bilateral lesions and increased prevalence of possible autonomous and autonomous cortisol secretion.

Conclusions: Adrenal lesions are common in the adult population, and while it is important to avoid overtreatment, hormone secretion, and malignancy should not be overlooked.

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在一个大型患者队列中,肾上腺病变的许多方面:在过去的二十年中发生了什么变化?
目的:回顾21年来肾上腺病变患者的表现特点、临床和激素评估以及组织病理学结果,并评估20年来肾上腺病变患者的变化。方法:这项单中心回顾性研究纳入了2000年至2021年间到我科就诊的1003例肾上腺病变患者。收集患者的临床、代谢、激素、放射学和病理资料。结果:47%的病变为无功能肾上腺腺瘤。22.2%的患者检测到可能的自主和自主皮质醇分泌。诊断为嗜铬细胞瘤、原发性醛固酮增多症、肾上腺库欣综合征、肾上腺皮质癌和肾上腺转移的比例分别为7.4%、4.8%、4.7%、0.9%和5.6%。31.3%的患者行肾上腺切除术。肾上腺功能病变是手术的主要原因(46.5%),其次是大尺寸和/或可疑的影像学特征(38.6%)。因体积较大(≥6cm)而行手术的患者中,19%诊断为转移,12.1%诊断为原发性肾上腺皮质癌。在大小为4 ~ 6cm且影像学特征可疑的肾上腺皮质病变中,转移率为44.4%,原发性肾上腺皮质癌为4.8%。从第一个十年到第二个十年,表现特征的主要差异是双侧病变的检测增加,以及可能自主和自主皮质醇分泌的患病率增加。结论:肾上腺病变在成年人中很常见,虽然避免过度治疗很重要,但激素分泌和恶性肿瘤也不应被忽视。
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来源期刊
CiteScore
4.10
自引率
5.60%
发文量
72
审稿时长
3 months
期刊介绍: Publishing outstanding articles from all fields of endocrinology and diabetology, from molecular biology to clinical research, this journal is a brilliant resource. Since being published in English in 1983, the popularity of this journal has grown steadily, reflecting the importance of this publication within its field. Original contributions and short communications appear in each issue along with reviews addressing current topics. In addition, supplementary issues are published each year presenting abstracts or proceedings of national and international scientific meetings. The journal was initially published in German and is still the oldest endocrinological periodical in the German-language market!
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