İNSİDENTAL ADRENAL LEZYONLARIN KLİNİK, HORMONAL VE HİSTOLOJİK DEĞERLENDİRİLMESİ: TEK MERKEZ SONUÇLARI

Yıl 2020, , 150 - 156, 11.05.2020

Şafak Akın , Selçuk Dağdelen Bülent Okan Yıldız Alper Gürlek Tomris Erbaş Miyase Bayraktar

https://doi.org/10.18229/kocatepetip.507301

Öz

AMAÇ: Adrenal insidentaloma günümüzde radyolojik görüntüleme yöntemlerinin yaygın kullanılmasıyla beraber klinikte sıkça karşılaştığımız bir problemdir. Bu çalışmada adrenal insidentaloma (Aİ) tanılı hastaların genel özelliklerinin değerlendirilmesi amaçlanmıştır.
GEREÇ VE YÖNTEM: Çalışmada 2001-2013 yılları arasında Hacettepe Üniversitesi Tıp Fakültesi Hastanesi’nde Aİ tanısı alıp takip edilen hastaların klinik ve laboratuvar sonuçları retrospektif olarak incelenmiştir.
BULGULAR: Çalışmaya 543 hasta dahil edildi. Hastaların 315 (%58)’ i kadın, 228 (%42)’ i erkekti (p<0.001). Ortalama tanı yaşı 56.71 ± 11.79 yıl idi. Fonksiyonel değerlendirmesi tam yapılan hastaların %76.2’si fonksiyonsuz adenom, %11.4’ü feokromositoma, %9.9’u subklinik Cushing sendromu (SCS), %1.6’si Cushing sendromu, %0.5’i hiperaldosteronizm ve %0.5’i katekolamin, glukokortikoid, mineralokortikoid ve androjen yüksekliği vakası idi. Yüzsekiz adrenalektomi yapılan hastanın, 28 (%26)’i adrenokortikal adenom, 15 (%14)’i feokromasitoma, 14 (%13)’ü adrenokortikal karsinom, ve diğer nadir tümör tipleri idi. Opere olan hastalar, olmayanlardan daha gençti (ortalama yaş, 54; sınırlar, 18-83; vs 57, 27-105 yaş, p < 0.001). Tüm Aİ serisinin ortanca sağ kalımı 101 ay [standart hata (SE): 15.1; %95 güven aralığı: 71.4-130.6] olarak saptandı.
SONUÇ: Adrenal insidentaloma toplumda sık görülmektedir ve nispeten basit ve ucuz tanı yöntemlerine ihtiyaç vardır. İlk tanı anında düzgün ve güvenilir tanı testleri ile değerlendirilme yapılmalıdır. Uzun dönemde opere olan ve olmayan hastaların verilerinin karşılaştırıldığı çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

Adrenal İnsidentaloma, Feokromositoma, Subklinik Cushing Sendromu

SONUÇLARICLINICAL, HORMONAL AND HISTOLOGICAL EVALUATION OF INCIDENTAL ADRENAL LESIONS: SINGLE CENTER RESULTS

Öz

OBJECTIVE: Adrenal incidentaloma is a problem that is frequently encountered clinically with the widespread use of radiological imaging methods. In this study, it was aimed to evaluate the general characteristics of patients with adrenal incidentaloma (AI).
MATERIAL AND METHODS: Clinical and laboratory results of the patients who were diagnosed and followed up at the Hacettepe University Medical Faculty Hospital between 2001 and 2013 were retrospectively analyzed.
RESULTS: 543 patients were included in the study. 315 (58%) of the patients were female and 228 (42%) were male (p <0.001). The mean age at diagnosis was 56.71 ± 11.79 years. Hormonal work-up demonstrated that 76.2% of the masses were non functional adenoma 11.4% were pheochromocytoma, 9.9% were defined as subclinical Cushing’s syndrome (SCS), 1.6% Cushing’s syndrome, 0.5% were hyperaldosteronism and 0.5% patient concomitant secretion of glucocorticoid, mineralocorticoid, androgen, and catecholamines. Adrenalectomy was performed in 108 patients with removal of 28 adrenocortical adenomas (26%), 15 pheochromocytoma (14%), 14 adrenocortical carcinomas (13%) and other less frequent tumor types. Operated patients were younger than the others (mean age, 54; range, 18-83; vs 57, 27-105, p <0.001). The median survival of the entire AI series was 101 months [standard error (SE): 15.1; 95% confidence interval: 71.4-130.6].
CONCLUSIONS: Adrenal incidentaloma is common in the community and relatively simple and inexpensive diagnostic methods are needed. At the first diagnosis, evaluation should be made with proper and reliable diagnostic tests. There is a need for studies comparing the data of patients who have been operated and not operated in the long period.

Anahtar Kelimeler

Adrenal incidentaloma, pheochromocytoma, subclinical Cushing’s syndrome

Kaynakça

• KAYNAKLAR1. Kloos RT, Gross MD, Francis IR, Korobkin M, Shapiro B. Incidentally discovered adrenal masses. Endocrine reviews. 1995; 16:460-484.
• 2. Herrera MF, Grant CS, van Heerden JA, Sheedy PF, Ilstrup DM. Incidentally discovered adrenal tumors: an institutional perspective. Surgery. 1991; 110:1014-1021.
• 3. Bovio S, Cataldi A, Reimondo G, et al. Prevalence of adrenal incidentaloma in a contemporary computerized tomography series. J Endocrinol Invest. 2006; 29:298-302.
• 4. Young WF, Jr. Management approaches to adrenal incidentalomas. A view from Rochester, Minnesota. Endocrinol Metab Clin North Am. 2000; 29:159-185.
• 5. Mantero F, Terzolo M, Arnaldi G, et al. A survey on adrenal incidentaloma in Italy. Study Group on Adrenal Tumors of the Italian Society of Endocrinology. 2000; 85:637-644.
• 6. Belldegrun A, Hussain S, Seltzer SE, Loughlin KR, Gittes RF, Richie JP. Incidentally discovered mass of the adrenal gland. Surg Gynecol Obstet. 1986; 163:203-208.
• 7. Cho YY, Suh S, Joung JY, et al. Clinical characteristics and follow-up of Korean patients with adrenal incidentalomas. Korean J Intern Med. 2013; 28:557-564.
• 8. Haissaguerre M, Courel M, Caron P, et al. Normotensive incidentally discovered pheochromocytomas display specific biochemical, cellular, and molecular characteristics. J Clin Endocrinol Metab. 2013; 98(11):4346-54 .
• 9. Mitchell IC, Auchus RJ, Juneja K, et al. "Subclinical Cushing's syndrome" is not subclinical: improvement after adrenalectomy in 9 patients. Surgery. 2007; 142:900-905. 10. Reincke M, Nieke J, Krestin GP, Saeger W, Allolio B, Winkelmann W. Preclinical Cushing's syndrome in adrenal "incidentalomas": comparison with adrenal Cushing's syndrome. J Clin Endocrinol Metab. 1992; 75:826-832.
• 11. Abdelmannan D, Aron DC. Adrenal incidentalomas and subclinical Cushing's syndrome. Rev Endocr Metab Disord. 2010; 11:135-140.
• 12. Tsuiki M, Tanabe A, Takagi S, Naruse M, Takano K. Cardiovascular risks and their long-term clinical outcome in patients with subclinical Cushing's syndrome. Endocr J. 2008; 55:737-745.
• 13. Toniato A, Merante-Boschin I, Opocher G, Pelizzo MR, Schiavi F, Ballotta E. Surgical versus conservative management for subclinical Cushing syndrome in adrenal incidentalomas: a prospective randomized study. Ann Surg. 2009; 249:388-391.
• 14. Libe R, Dall'Asta C, Barbetta L, Baccarelli A, Beck-Peccoz P, Ambrosi B. Long-term follow-up study of patients with adrenal incidentalomas. Eur J Endocrinol. 2002; 147:489-494.
• 15. Terzolo M, Reimondo G, Angeli A. Definition of an optimal strategy to evaluate and follow-up adrenal incidentalomas: time for further research. Eur J Endocrinol. 2009; 161:529-532.
• 16. Vassilatou E, Vryonidou A, Michalopoulou S, et al. Hormonal activity of adrenal incidentalomas: results from a long-term follow-up study. Clin Endocrinol (Oxf). 2009; 70:674-679.
• 17. Nieman LK, Biller BM, Findling JW, Newell-Price J, Savage MO, Stewart PM, Montori VM. The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline. 2008; 93:1526-1540.
• 18. Funder JW, Carey RM, Fardella C, et al. Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2008; 93:3266-3281.
• 19. Barzon L, Sonino N, Fallo F, Palu G, Boscaro M. Prevalence and natural history of adrenal incidentalomas. Eur J Endocrinol. 2003; 149:273-285.
• 20. Icard P, Goudet P, Charpenay C, et al. Adrenocortical carcinomas: surgical trends and results of a 253-patient series from the French Association of Endocrine Surgeons study group. World J Surg. 2001; 25:891-897.
• 21. Kasperlik-Zaluska AA, Migdalska BM, Makowska AM. Incidentally found adrenocortical carcinoma. A study of 21 patients. Eur J Cancer. 1998; 34:1721-1724.
• 22. Young WF, Jr. Clinical practice. The incidentally discovered adrenal mass. The New England journal of medicine. 2007; 356:601-610.