488例肾上腺意外瘤住院患者临床特征及诊疗

Clinical research of 488 inpatients with adrenal incidentaloma

摘要:

目的： 分析肾上腺意外瘤（adrenal incidentaloma，AI）的临床特点和诊治现状。方法： 回顾性分析2012年1月至2018年12月在北京大学第一医院住院，符合AI诊断标准的488例患者病例资料。结果： ①488例AI患者中，326例（66.80%）为体检发现，409例（83.81%）为无功能占位；②180例经手术治疗的AI患者中，27例（15.00%）病理诊断为嗜铬细胞瘤，甲氧基去甲肾上腺素（normetanephrine，NMN）诊断效力曲线下面积为0.906，灵敏度为92.9%，特异度为81.6%，约登指数为0.745；计算机断层扫描（computed tomography，CT）联合血去甲肾上腺素、尿去甲肾上腺素诊断曲线下面积为0.828，敏感度为77.8%，特异度为85.3%，约登指数为0.631；③评估隔夜1 mg地塞米松抑制试验对亚临床库欣综合征（subclinical Cushing’s syndrome，SCS）的诊断价值，抑制后皮质醇最佳切点为2.1 μg/dL，曲线下面积为0.967，敏感度为93.3%，特异度为92.4%，约登指数为0.857；④65例无功能AI随访半年至7年，2例进展为SCS；⑤31例<1 cm的肾上腺占位，仅2例（6.45%）为原醛症。结论： ①2/3的AI为常规体检发现，是意外瘤发病率增加的主要原因，84%为无功能占位；②CT联合血、尿去甲肾上腺素诊断嗜铬细胞瘤的价值不及血NMN；③隔夜1 mg地塞米松抑制试验诊断SCS的最佳切点为2.1 μg/dL，优于1.8 μg/dL；④无功能AI有进展为亚临床库欣可能；⑤<1 cm的肾上腺占位功能评价意义不大，可能仅需影像学随访。

Abstract:

Objective: To analyze the clinical characteristics and current status of diagnosis and treatment of adrenal incidentaloma (AI). Methods: Clinical data of 488 patients admitted to Peking University First Hospital who met the AI diagnostic criteria from January 2012 to December 2018 were retrospectively analyzed. Results: ① Of the 488 AI patients, 326 cases (66.80%) were found during physical examination, 409 cases (83.81%) were non-functional lesion. ② There were 180 cases received surgical treatment, among which 27 patients (15.00%) were pathologically diagnosed as pheochromocytoma. The area under curve of blood normetane-phrine (NMN) in the diagnosis of pheochromocytoma was 0.906, with the sensitivity of 92.9%, the specificity of 81.6%, and the Youden’s index of 0.745. The area under curve of the joint test by computed tomography (CT), blood norepinephrine (NE) and urine NE was 0.828, with the sensitivity of 77.8%, the specificity of 85.3%, and the Youden’s index of 0.631. ③ To evaluate the diagnostic value of overnight 1 mg dexamethasone inhibition test for subclinical Cushing’s syndrome (SCS), the area under curve of the 1 mg overnight dexamethasone inhibition test in diagnosis of SCS was 0.967, the optimal cut-off point was 2.1 μg/dL, with the sensitivity of 93.3%, the specificity of 92.4%, and the Youden’s index of 0.857. ④ A total of 65 patients of non-functional AI were followed up for 6 months to 7 years, and only 2 cases progressed to SCS. ⑤ There were 31 additional cases of adrenal mass<1 cm, and only 2 cases (6.45%) were primary aldosteronism. Conclusion: ① Two thirds of AI was found by routine physical examination, which was the main reason for the increase of incidence of accidental tumor, and 84% of which was non-functional lesions. ② The value of CT combined with blood NE and urine NE in the diagnosis of pheochromocytoma is lower than that of blood NMN. ③ The optimal cut-off point for the 1 mg overnight dexamethasone inhibition test diagnosis of SCS is 2.1 μg/dL, which is better than 1.8 μg/dL. ④ Non-functional AI may progress to SCS. ⑤ The clinical significance of adrenal lesions<1 cm function evaluation is unlikely to require, while imaging follow-up may be only required.