肾上腺偶发瘤患者的治疗方法。案例系列

D. Ladygina, A. Zorina, M. Berkovskaya, A. Chevais, D. Beltsevich, V. Fadeev
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引用次数: 0

摘要

由于其他原因,在对腹腔和腹膜后间隙进行仪器检查时,经常会意外发现肾上腺的形成。在过去的20年里,肾上腺形成的检测频率增加了10倍,其中大多数是在老年时诊断出来的。观察和治疗策略既取决于激素活性,也取决于检测到的形成物的恶性潜能。高达58%的肾上腺偶发瘤患者具有恶性性质,年轻患者的风险更高,其大小超过4厘米,并且有其他恶性肿瘤病史。皮质激素增多症、醛固酮增多症或儿茶酚胺产生肿瘤的经典临床和实验室图像的检测频率不到15%,然而,根据过去几年进行的研究结果,功能自主产生皮质醇的现象在3050%的患者中更为常见。尽管在某些情况下没有明显的临床症状,但自主皮质醇分泌与心血管发病率和代谢紊乱的增加有关,因此,所有肾上腺偶发瘤患者都需要排除这种情况。本文介绍了肾上腺形成患者的临床病例,详细描述了检查算法和治疗策略的选择,考虑到自2016年发布肾上腺偶发瘤患者管理的最新临床建议以来进行的研究结果。
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Approach to the patient with adrenal incidentaloma. Case series
The formations of the adrenal glands are often detected accidentally during instrumental methods of examination of the abdominal cavity and retroperitoneal space, performed for some other reasons. Over the past 2 decades, the frequency of detection of adrenal gland formations has increased 10-fold, and most of them are diagnosed in old age. The tactics of observation and treatment depend both on hormonal activity and on the malignant potential of the detected formation. Up to 58% of patients with adrenal incidentalomas have a malignant nature, with a higher risk in young patients, with a size of more than 4 cm, as well as with a history of other malignant neoplasms. The frequency of detection of the classical clinical and laboratory picture of hypercorticism, hyperaldosteronism or catecholamine-producing tumor is less than 15%, however, the phenomenon of functionally autonomous cortisol production according to the results of studies conducted in the last few years is much more common up to 3050% of patients. Despite the absence of vivid clinical symptoms in some cases, autonomous cortisol secretion is associated with increased cardiovascular morbidity and metabolic disorders, therefore, all patients with adrenal incidentalomas need to exclude this condition. This article presents clinical cases of patients with adrenal gland formations, describes in detail the examination algorithm and the choice of treatment tactics, taking into account the results of studies conducted since the release of the latest clinical recommendations for the management of patients with adrenal gland incidentalomas in 2016.
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