Surrenal Kitle Saptanan Hastaların Klinik, Labaratuar ve Radyolojik Bulguları; Tek Merkez Deneyimi

Yıl 2021, Cilt: 18 Sayı: 1, 132 - 137, 28.04.2021

Suzan Tabur , Sadettin Ozturk , Onur Ağcabay , Ersin Akarsu , Mustafa Araz

https://doi.org/10.35440/hutfd.884977

Öz

Amaç: Sürrenal insidentolamalar, başka nedenlerle yapılan görüntüleme testleri sırasında tesadüfen saptanan kitlelerdir. Günümüzde abdominal görüntüleme tekniklerinin yaygın olarak kullanılmaya başlanması ile birlikte sürrenal insidentaloma tanısının sıklığı artmıştır. Her adrenal insidentaloma, malign olup olmadığı ve hormonal işlevi olup olmadığı açısından değerlendirimelidir. Bu değerlendirme tedavi planlanması ve hastanın takibi için önemlidir.
Materyal ve Metod: Toplam 68 sürrenal kitlesi olan vakanın klinik, radyolojik, hormonal ve labaratuvar takiplerini retrospektif değerlendirdik.
Bulgular: Vakaların %58,8’i kadın (n:40), %41,2’si erkekti (n:28). Bu hastalardan 36’sı bilgisayarlı tomografi, 22’si bilgisayarlı tomografi ve manyetik rezonans görüntüleme, 10 tanesi de manyetik rezonans görüntüleme sonuçlarına göre değerlendirilmiştir. Adrenal insidentalomaların kitle çapı 4-95 mm idi. Adrenal insidentalomalı hastaların %42’si (n:29) opere edilmişti. Otuz beş hastada non-fonksiyone adenom(NFA) saptanırken, 33 hastada fonksiyonel adenom(FA) saptanmıştır. Klinikopatolojik değerlendirilmelerine göre surrenal kitlelerde 22 (%32,3) adet feokromositoma, 7 (%10,2) adet cushing sendromu ve 4(%1,4) adet conn sendromu saptanmıştır. Eşlik eden hastalıklar açısından değerlendirildiğinde; surrenal kitlesi olan hastalardan 15’inde (% 22,1) hipertansiyon ve diabetes mellitus, 26’sında (%38,2) diabetes mellitus, 27’sinde (%39,7) komorbidite olmadığı görüldü.
Sonuç: Çalışmamızdaki adrenal insidentaloma vakalarının çoğu non-fonksiyone adenomdur. Fonksiyone adenomlar içinde klinik olarak en çok feokromositoma ve daha sonra ise cushing sendromu saptanmıştır. Adrenal kitlelerin cerrahiye gidişinde fonksiyonel olmaları ve boyutları belirleyicidir.

Anahtar Kelimeler

sürrenal insidentaloma, feokromositoma, , Cushing sendromu, hiperaldosteronizm, sürrenal incidentaloma, pheochromocytoma, Cushing syndrome, hypereraldosteronism

Destekleyen Kurum

destekleyen kurum bulunmamaktadır.

Clinical, Laboratory and Radiological Findings of Patients with Surrenal Mass; Single Center Experience

Öz

Background: Adrenal inincidentolamas are masses that are incidentally detected during imaging tests performed for other reasons. Nowadays, with the wide spread use of abdominal imaging techniques, the frequency of adrenal incidentaloma diagnosis has increased. Every adrenal incidentaloma should be evaluated for whether it is malignant and hormonally functional. This evaluation is important for treatment planning and follow-up.
Materials and Methods: We retrospectively evaluated the clinical, radiological, hormonal and laboratory follow-up of total 68 cases with adrenal masses.
Results: 58.8% of the cases were female (n:40), 41.2% were male. Thirty six of the patients were evaluated according to the results of computerize tomography, 22 of the manyetic rezonans ımaging and computerize tomography, 10 of the manyetic rezonans imaging. The mass diameter of adrenal incidentalomas was 4-95 mm. 42% (n: 29) of the patients with adrenal incidentaloma were operated. Non-functional adenoma (NFA) was found in 35 patients, whereas functional adenoma (FA) was found in 33 patients. According to clinicopathological evaluations; 22 (32.3%) pheochromocytoma, 7 (10.2%) cushing syndrome and 4 (1.4%) conn syndrome were found in surrenal masses. When evaluated in terms of accompanying diseases; 15 of the patients had both hypertension and diabetes, 26 of the patients had diabetes and 27 of them had no comorbidities.
Conclusions: Most of the adrenal incidentaloma cases in our study are non-functional adenomas. Among the functional adenomas, pheochromocytoma have been detected more commonly and this is followed by cushing syndrome. Functionality and size of them were decisive in the course of surgery.

Key Words: Surrenal incidentaloma, Pheochromocytoma, Cushing syndrome, Hypereraldosteronism

Kaynakça

• Referans1.Barzon, L., Sonino, N., Fallo, F., Palu, G., &Boscaro, M. (2003). Prevalenceandnaturalhistory of adrenal incidentalomas. Europeanjournal of endocrinology, 2003; 149(4): 273-286.
• Referans2. Young JR, William F. Management approachesto adrenal incidentalomas: a viewfrom Rochester, Minnesota. Endocrinologyandmetabolismclinics of North America. 2000; 29(1): 159-185.
• Referans3.Terzolo, M., Pia, A., Alì, A., Osella, G., Reimondo, G., Bovio, S. et. al. Adrenal incidentaloma: a newcause of the metabolic syndrome?. TheJournal of Clinical Endocrinology&Metabolism. 2002; 87(3): 998-1003.
• Referans4. Erbil, Y., Barbaros, U. Management of the adrenal incidentalomas. Turkiye Klinikleri J Gen Surg-Special Topics. 2008; 1: 6-10.
• Referans5.Minowada, S., Fujimura, T., Takahashi, N., Kishi, H., Hasuo, K., &Minami, M. Computed tomography-guided percutaneous aceticacid injection therapy for functioning adrenocortical adenoma. The Journal of ClinicalEndocrinology&Metabolism. 2003; 88(12): 5814-5817.
• Referans6. Mantero, F., Terzolo, M., Arnaldi, G., Osella, G., Masini, A. M., Alı̀, A. et all. Study Group on Adrenal Tumors of the Italian Society of Endocrinology. A survey on adrenal incidentaloma in Italy. TheJournal of Clinical Endocrinology&Metabolism. 2000; 85(2): 637-644.
• Referans7. Moreira Jr, Sergio G.&Pow-Sang, J. M.. Evaluation and management of adrenal masses. Cancer Control. 2002; 9(4); 326-334.
• Referans8. Mantero, F., &Albiger, N. A comprehensive approach to adrenal incidentalomas. Arquivos Brasileiros de Endocrinologia&Metabologia. 2004; 48(5): 583-591.
• Referans9. Grumbach, M. M., Biller, B. M., Braunstein, G. D., Campbell, K. K., Carney, J. A., Godley, et all. Management of the clinically in apparent adrenal mass (incidentaloma). Annals of internal medicine. 2003; 138(5): 424-429.
• Referans10.Kay, R. (1982). Schumacher 0P, Tank BS. Adrenocortical carcinoma in children. J Urol. 1982; 130: 1130-9.
• Referans11.Nader, S., Hickey, R. C., Sellin, R. V., &Samaan, N. A. (1983). Adrenal cortical carcinoma a study of 77cases. Cancer. 1983; 52(4); 707-711.
• Referans12. Barzon, L., Sonino, N., Fallo, F., Palu, G., &Boscaro, M. (2003). Prevalence and natural history of adrenal incidentalomas. Europeanjournal of endocrinology. 2003; 149(4): 273-286.
• Referans13. Murphy, J. M., & La Quaglia, M. P. Advances in thesurgical treatment of neuroblastoma: a review. European Journal of Pediatric Surgery. 2014; 24(06): 450-456.
• Referans14. Kloos, R. T., Gross, M. D., Francis, I. R., Korobkin, M., &Shapiro, B. Incidentally discovered adrenal masses. Endocrine reviews. 1995; 16(4): 460-484.
• Referans15. Mannsmann, G., &Bornstein, S. R. The Clinically Inapparent Adrenal Mass: Update in Diagnosis and Management. Hormone and Metabolic Research. 2004; 36(06): 25.
• Referans16.Erdoğan, G. Adrenal korteks genel bilgiler ve adrenal korteks hastalıkları. Endokrinoloji ve temel ve klinik. MN Medical; Ankara, 2005: 525-60.
• Referans17.Mantero, F., Terzolo, M., Arnaldi, G., Osella, G., Masini, A. M., Alı̀, et all. Study Group on Adrenal Tumors of the Italian Society of Endocrinology. A survey on adrenal incidentaloma in Italy. TheJournal of Clinical Endocrinology&Metabolism. 2000; 85(2): 637-644.
• Referans18.Tütüncü, N. B., & Gedik, O. Adrenal incidentaloma: report of 33 cases. Journal of surgical oncology. 1999; 70(4): 247-250.
• Referans19. Barzon, L., Fallo, F., Sonino, N., &Boscaro, M. Development of overt Cushing'ssyndrome in patients with adrenal incidentaloma. European Journal of Endocrinology. 2002; 146(1): 61-66.
• Referans20. Favia, G., Lumachi, F., Basso, S., &D'Amico, D. F. (2000). Management of incidentally discovered adrenal masses and risk of malignancy. Surgery. 2000; 128(6): 918-924.
• Referans21. Herrera, M. F., Grant, C. S., vanHeerden, J. A., Sheedy, P. F., &Iistrup, D. M. (1991). Incidentally discovered adrenal tumors: an institutional perspective. Surgery. 1991; 110(6): 1014-1021.
• Referans22. Cho, Y. Y., Suh, S., Joung, J. Y., Jeong, H., Je, D., Yoo, H., et all. Clinical characteristics and follow-up of Korean patients with adrenal incidentalomas. The Korean journal of internal medicine. 2013; 28(5); 557.
• Referans23. Mitchell, I. C., Auchus, R. J., Juneja, K., Chang, A. Y., Holt, S. A., Snyder III, W. H., &Nwariaku, F. E.. “SubclinicalCushing’s syndrome” is not subclinical: improvement after adrenalectomy in 9 patients. Surgery. 2007; 142(6): 900-905.
• Referans24. Reincke, M., Nieke, J., Krestin, G. P., Saeger, W., Allolio, B. &Winkelmann, W..(1992). Preclinical Cushing's syndrome in adrenal" incidentalomas": comparison with adrenal Cushing's syndrome. TheJournal of Clinical Endocrinology&Metabolism. 1992; 75(3): 826-832.
• Referans25. Abdelmannan, D., &Aron, D. C. Adrenal incidentalomas and subclinical Cushing’ssyndrome. Reviews in endocrine and metabolic disorders. 2010; 11(2): 135-140.
• Referans26. Tsuiki, M., Tanabe, A., Takagi, S., Naruse, M., &Takano, K. (2008). Cardiovascular risks and their long-term clinica loutcome in patients with subclinical Cushing's syndrome. Endocrinejournal. 2008; 0805020129-0805020129.
• Referans27. Toniato, A., Merante-Boschin, I., Opocher, G., Pelizzo, M. R., Schiavi, F., &Ballotta, E. (2009). Surgical versus conservative management for subclinical Cushing syndrome in adrenal incidentalomas: a prospective randomized study. Annals of surgery. 2009; 249(3): 388-391.
• Referans28. Haissaguerre, M., Courel, M., Caron, P., Denost, S., Dubessy, C., Gosse, P. et all.Normotensive incidentally discovered pheochromocytomas display specific biochemical, cellular, and molecular characteristics. TheJournal of Clinical Endocrinology&Metabolism. 2013; 98(11): 4346-4354.
• Referans29. Funder, J. W., Carey, R. M., Fardella, C., Gomez-Sanchez, C. E., Mantero, F., Stowasser, M. et all. 548 Montori VM, Endocrine S. Case detection, diagnosis, and treatment of patients with primary 549 aldosteronism: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2008; 550(93): 3266-3281.
• Referans30.Gonzaga, C. C., &Calhoun, D. A. Resistant hypertension and hyperaldosteronism. Current hypertension reports. 2008; 10(6): 496.