Çocukluk Çağı Sürrenal Bölge Kitlelerinin Değerlendirilmesi: Tek Merkez Deneyimi

Yıl 2024, , 323 - 327, 01.05.2024

Emel Hatun Aytaç Kaplan , Zümrüt Kocabey Sütçü , Seyithan Özaydın , Hasan Önal

https://doi.org/10.53394/akd.1282598

Öz

Amaç: Çocukluk çağında sürrenal kitleler nadirdir ancak saptandığında yakın takip gerektirmektedir. Çocukluk yaş grubunda sürrenal kitleler genellikle cerrahi girişim gerektirir. Epidemiyolojisi tam olarak bilinmemektedir. Sıklıkla neoplastik kitleler görülmekle birlikte erken yaşta yapılan rutin görüntülemeler adrenal hemorajilerin de nadir olmadığını göstermektedir (1). Bu çalışmada çocuk endokrin kliniği ile refere edilen sürrenal bölge kitlelerinin etyoloji, takip ve tedavi süreçlerinin değerlendirilmesi amaçlandı.
Yöntem: Çalışmamız 2021-2023 yılları arasında başvuran hastaların incelendiği, tek merkezli, retrospektif bir çalışmadır. Çalışmamızda çocuk endokrin kliniğine refere edilen, sürrenal bölge kitlesi tespit edilen 0-18 yaş aralığındaki 17 hasta retrospektif olarak incelendi.
Bulgular: Olguların %53,5’i hematom (n=9), %11,7’si nöroblastom (2), %5,8’i feokoromasitoma (n=1), %5,8’i paraganglioma (n=1), %5,8’i basit kist (n=1), %5,8’i kortikal fonksiyonel adenom tanısı aldı (n=1). İki (%11,7) hastanın patolojik tanısı yoktu ancak bulgu vermeyen, zamanla küçülen kitlelerdi. Hematom tanısı alan 3 hasta adrenal yetmezlik nedeniyle tedavi aldı. Paraganglioma tanısı alan hastanın tümörden ve periferik kandan bakılan SDHB (succinate dehydrogenase subunit B) geninde heterozigot, muhtemel patojenik, c.649C>G (p.Arg217Gly) varyant tespit edildi.
Sonuç: Çalışmamızda endokrin kliniklerinde izlenen sürrenal bölge kitlelerinin oldukça çeşitli etyolojilerde olduğunu göstermiş olduk.

Anahtar Kelimeler

çocukluk çağı, kitle, sürrenal

Destekleyen Kurum

YOKTUR

Evaluation of Childhood Surrenal Regional Masses: A Single Center Experience

Öz

Aim: Adrenal masses are rare in childhood, but when detected, close follow-up is mandatory. Childhood age cells adrenal masses usually require surgical intervention. Its epidemiology is well known. Although neoplastic masses are frequently seen, routine imaging at an early age shows that adrenal hemorrhages are not uncommon (1). In this study, it was aimed to evaluate the etiology, follow-up and treatment processes of adrenal region masses referred to the pediatric endocrine clinic.
Method: Our study is a single-center, retrospective study examining patients admitted between 2021-2023. In our study, 17 patients aged 0-18 years, who were referred to the pediatric endocrine clinic and diagnosed with adrenal region masses, were retrospectively analyzed.
Results: 53.5% of the cases were hematoma (n=9), 11.7% were neuroblastoma (2), 5.8% were pheochromocytoma (n=1), 5.8% were paraganglioma (n=1) , 5.8% got simple cyst (n=1), 5.8% got cortical functional adenoma (n=1). Two (11.7%) organs were absent in pathological examinations, but they were asymptomatic, shrinking masses. Three patients who underwent hematoma examination were treated for adrenal insufficiency. Heterozygous, possibly pathogenic, c.649C>G (p.Arg217Gly) predictor was detected in the SDHB (succinate dehydrogenase subunit B) gene analyzed from the tumor that received a paraganglioma case and from peripheral blood.
Conclusion: In our study, we showed that the adrenal region masses observed in endocrine clinics have various etiologies.

Anahtar Kelimeler

childhood, mass, surrenal

Kaynakça

• 1. Blassy C, Navarro OM, Daneman A: Adrenal masses in children. Radiol Clin North Am 2011; 49(4):711-27.
• 2. Iuchtman M, Breitgand A: Traumatic adrenal haemorrhage in children an indicator of visceral injury. Pediatr Surg Int 2000; 16(8):586-8.
• 3. Toti M S, Ghirri P, Bartoli A, Caputo C, Laudani E, Masoni F, Mele L, Bernardini R. Adrenal haemorrhagein newborn: how, when and why-from case report to literatüre review. Ital J Pediatr 2019; 45(1):58.
• 4. Gyurkovits Z, Gyurkovitz Z, Maroti A, Renes L, Nemeth G, Pal A, Orvos H. Adrenal haemorrhage in term neonates: a retrospective study from the period. 2001-2013. J Matern Fetal Neonatal Med 2015; 28(17): 2062-5.
• 5. Simon T, Hero B, Schulte JH, Deubzer H, Hundsdoerfer P, Von Schwenitz D, Fuchs J, Schmidt M, Prasad V, Krug B, Timmermann B, Leuschner I, Fischer M, Langer T, Astrahantseff K, Berthold F, Lode H, Eggert A. 2017 GPOH guidelines for diagnosis and treatment of patients with neuroblastic tumors. Klin Pediatr 2017; 229(3):147-67.
• 6. Emre Ş, Özcan R, Bakır AC, Kuruğoğlu S, Çomunoğlu N, Susam Şen H, Celkan T, Topuzlu Tekant G. Adrenal masses in children: Imaging, surgical treatment and outcome. Asian J Surg 2020; 43(1):207-12.
• 7. Zessis NR, Nicholas JL, Stone SI. Severe bilateral adrenal hemor- rhages in a newborn complicated by persistent adrenal insuf ciency. Endocrinol Diabetes Metab Case Rep 2018:17-0165.
• 8. Rumińska M, Welc-Dobies M, Lange M, Maciejewska J, Przak B, Brzewski M. Adrenal haemorrhage in neonates: risk factors and diagnostic and clinical procedure. Medycyna Wieku Rozwojowego 2008; 12(1):457–62.
• 9. Demirel N, Yağmur Baş A, Zenciroğlu A, Taşçı Yıldız Y. Adrenal bleeding in neonates: report of 37 cases. Turk J Pediatr 2011; 53(1):43-7.
• 10. Dheyaa Kadhim Al-Waeli, Abbas Ali Mansour, Nazar S Haddad. Reliability of adrenal computed tomography in predicting the functionality of adrenal incidentaloma. Niger Postgrad Med J 2020; 27(2):101-7.
• 11. Bholah R, Bunchman TE. Review of Pediatric Pheochromocytoma and Paraganglioma. Front Pediatr 2017; 5:155.
• 12. Neumann HPH, Young WF, Jr, Eng C. Pheochromocytoma and Paraganglioma. N İngilizce J Med 2019; 381:552–65.
• 13. van Nederveen FH, Gaal J, Favier J, Korpershoek E, Oldenburg RA, de Bruyn EM, Sleddens HF, Derkx P, Rivière J, Dannenberg H, Petri BJ, Komminoth P, Pacak K, Hop WC, Pollard PJ, Mannelli M, Bayley JP, Perren A, Niemann S, Verhofstad AA, de Bruïne AP, Maher ER, Tissier F, Méatchi T, Badoual C, Bertherat J, Amar L, Alataki D, Van Marck E, Ferrau F, François J, de Herder WW, Peeters MP, van Linge A, Lenders JW, Gimenez-Roqueplo AP, de Krijger RR, Dinjens WN. An immunohistochemical procedure to detect patients with paraganglioma and phaeochromocytoma with germline SDHB, SDHC, or SDHD gene mutations: a retrospective and prospective analysis. Lancet oncol 2009; 10(8):764-71.
• 14. Prodanov T, Havekes B, Nathanson K, Adams K, Pacak K. Malignant paraganglioma associated with succinate dehydrogenase subunit B in an 8-year- old child: the age of first screening?. Pediatr Nephrol 2009; 24(6):1239-42.
• 15. Nuchtern JG. Perinatal nöroblastoma. Seminars in pediatric surgery 2006; 15: 10-6.
• 16. Suzuki K, Watanabe N, Onuko M. A case of ciystic nöroblastoma observed from fetal period as a cystic lesion. Jpn J pediatr Oncol 2000; 37:251-4.
• 17. Türk pediatri ve onkoloji grubu (TPOG), İnfant Sürrenal Kitle İzlem Protokolü (İSKİP) 2011.