临床回顾:双侧肾上腺肿块的评估和治疗方法。

IF 3.7 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Endocrine Practice Pub Date : 2024-10-01 DOI:10.1016/j.eprac.2024.06.015
Ann T. Sweeney MD , Oksana Hamidi DO , Prerna Dogra MD , Shobana Athimulam MD , Ricardo Correa MD , Michael A. Blake MB, BCh , Travis McKenzie MD , Anand Vaidya MD , Karel Pacak MD, PhD, DSc , Amir H. Hamrahian MD , Irina Bancos MD
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引用次数: 0

摘要

目的:本白皮书为临床医生在遇到双侧肾上腺肿块时提供实用指导:本白皮书为遇到双侧肾上腺肿块的临床医生提供实用指导:方法:以病例为基础,评估和处理双侧肾上腺肿块。本文介绍的具体临床情景包括双侧肾上腺腺瘤、出血、嗜铬细胞瘤、转移性疾病、髓脂瘤以及原发性双侧大结节性肾上腺增生症等病例:双侧肾上腺肿块约占偶然发现的肾上腺肿块的10%至20%。评估和处理双侧肾上腺肿块的一般方法与评估单侧肾上腺肿块的方法相同,根据患者的临床病史和检查以及每个病变的影像学特征、病变是否可能代表恶性肿瘤、是否显示激素过多或是否可能代表家族综合征来决定。此外,双侧肾上腺肿块还具有一些独特的特征,必须加以考虑,包括鉴别诊断、评估和根据病因进行的处理。因此,建议中包括了最佳成像方式、治疗(药物治疗与手术治疗)和监测的注意事项。这些建议是在仔细研究了现有的已发表研究以及专家临床意见共识的基础上提出的:双侧肾上腺肿块的评估和管理需要全面系统的方法,包括评估和解释患者的临床病史、体格检查、动态激素评估和影像学检查,以确定每个肾上腺结节的主要影像学特征。此外,还应考虑家族综合征。任何最终治疗方案和方法都应单独考虑。
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Clinical Review: The Approach to the Evaluation and Management of Bilateral Adrenal Masses

Objective

This white paper provides practical guidance for clinicians encountering bilateral adrenal masses.

Methods

A case-based approach to the evaluation and management of bilateral adrenal masses. Specific clinical scenarios presented here include cases of bilateral adrenal adenomas, hemorrhage, pheochromocytomas, metastatic disease, myelolipomas, as well as primary bilateral macronodular adrenal hyperplasia.

Results

Bilateral adrenal masses represent approximately 10% to 20% of incidentally discovered adrenal masses. The general approach to the evaluation and management of bilateral adrenal masses follows the same protocol as the evaluation of unilateral adrenal masses, determined based on the patient’s clinical history and examination as well as the imaging characteristics of each lesion, whether the lesions could represent a malignancy, demonstrate hormone excess, or possibly represent a familial syndrome. Furthermore, there are features unique to bilateral adrenal masses that must be considered, including the differential diagnosis, the evaluation, and the management depending on the etiology. Therefore, considerations for the optimal imaging modality, treatment (medical vs surgical therapy), and surveillance are included. These recommendations were developed through careful examination of existing published studies as well as expert clinical opinion consensus.

Conclusion

The evaluation and management of bilateral adrenal masses require a comprehensive systematic approach which includes the assessment and interpretation of the patient’s clinical history, physical examination, dynamic hormone evaluation, and imaging modalities to determine the key radiographic features of each adrenal nodule. In addition, familial syndromes should be considered. Any final treatment options and approaches should always be considered individually.
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来源期刊
Endocrine Practice
Endocrine Practice ENDOCRINOLOGY & METABOLISM-
CiteScore
7.60
自引率
2.40%
发文量
546
审稿时长
41 days
期刊介绍: Endocrine Practice (ISSN: 1530-891X), a peer-reviewed journal published twelve times a year, is the official journal of the American Association of Clinical Endocrinologists (AACE). The primary mission of Endocrine Practice is to enhance the health care of patients with endocrine diseases through continuing education of practicing endocrinologists.
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