Adrenal insidentalomalı hastaların klinik, laboratuvar ve radyolojik özelliklerinin retrospektif olarak değerlendirilmesi
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Date
2015
Authors
Peynirci, Hande
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Publisher
Uludağ Üniversitesi
Abstract
Adrenal hastalığa bağlı olmayan klinik durumların tetkik veya tedavisi sırasında tesadüfen saptanan adrenal kitleler insidentaloma olarak tanımlanmaktadır. Malign hastalık evrelendirmesi veya takibi esnasında saptanan adrenal kitleler bu tanımın içine dahil edilmemektedir. Yaşla birlikte adrenal insidentaloma saptanma insidansı arttığı ve radyolojik tetkiklerin farklı nedenlerle kullanımı yaygınlaştığı için bu konuya olan ilgi gittikçe artmaktadır. Adrenal insidentalomaların prevelansı verilerin kaynağına (otopsi veya radyolojik seriler) ve seçilen hasta grubuna (genel popülasyon veya özel hasta kategorileri) göre değişmektedir. Prevalansı otopsilerde %1-8.7 ve radyolojik serilerde %0.5-4.4 olarak bildirilmiştir. Çalışmalardaki heterojenite, rölatif olarak az sayıyı kapsaması, uzun dönemli takiplerin eksikliği adrenal insidentalomaların tanı ve tedavisinde belirsizliklere yol açmaktadır. Biz de bu çalışmada 3 yıllık dönemde adrenal insidentaloma ile başvuran veya takipte olan 523 hastanın klinik özelliklerini, hormonal durumunu, görüntüleme yöntemlerindeki özelliklerini, tedavilerini ve histolojik tanılarını retrospektif olarak değerlendirmeyi amaçladık. Olguların 354'ü (%67.7) kadın, 169'u (%32.3) erkek ve yaşlarının ortalama değeri 55.70 yıl (±11.29) idi. Hastalarımız hormonal aktivite açısından değerlendirildiğinde, %77.2'sinin (n:404) hormonal açıdan nonfonksiyonel, %13.0'ünün (n:68) Cushing sendromu, %6.1'inin (n:32) feokromositoma ve %3.6'sının (n:19) primer hiperaldosteronizm olduğu saptandı. Adrenal insidentalomaların temel görüntüleme yöntemi olan bilgisayarlı tomografi verileri değerlendirildiğinde kitlelerin %40.9'u (n:178)sağ tarafta ve %43.7'si (n:190) sol tarafta idi. Taraflar açısından anlamlı farklılık yoktu. Ortalama kitle boyutu 30 mm olarak saptandı. Dört grup birbiri ile karşılaştırıldığında, feokromositomada kitlelerin boyutunun diğer gruplardan daha büyük, primer hiperaldosteronizmde ise diğer gruplara kıyasla daha küçük olduğu bulundu. Kitlelerin çoğunluğu (%79.7) adenomatöz karakterde idi ve ortalama Hounsfield Ünitesi -1.50 (±17.72) bulundu. Çalışmaya alınan 523 hastadan 358'inin (%68.4) takip edildiği, 141'inin (%27) opere edildiği, 3'ünün (%0.6) medikal tedavi ile izlendiği ve 21'inin (%4) takipsiz kaldığı belirlendi. Opere olan 141 hastanın 45'inin nonfonksiyonel adenom, 50'sinin Cushing sendromu, 31'inin feokromositoma ve 15'inin primer hiperaldosteronizm olduğu belirlendi. Opere olan hastaların patolojik preperatları değerlendirildinde 78'inin patolojik tanısının benign adenom olarak raporlandığı tespit edildi. Hastaların %1.7'sinin (n:9) adrenokortikal karsinom olduğu saptandı. Hastaların takiplerinde 351 hastanın (%67.1) stabil seyrettiği, 117 hastanın (%22.4) remisyona girdiği, 44 hastanın (%8.4) takipsiz kaldığı, 11 hastada (%2.1) hastalığın nüks ettiği belirlendi. Sonuç olarak çalışmamız göstermiştir ki, adrenal kitlelerin malignite olasılığı göz önünde tutularak değerlendirilmesi gerekmektedir. Ayrıca, adrenal insidentalomalı hastaların endokrinolojik değerlendirmesi azımsanmayacak sayıda hormonal aktif lezyonların tanımlanmasına ve tedavi edilebilmesine yol açmaktadır.
The serendipitous discovery of adrenal masses during evaluation and treatment of clinical status unrelated to adrenal disease are defined as incidentalomas. The adrenal masses detected during staging and follow-up of malignancies are not included into this definition. This subject increasingly draws attention because of the increased incidence of adrenal masses by aging and widespread use of imaging modalities due to various causes. The prevalence of adrenal incidentalomas vary according to the source of data collection (autopsy and radiologic series) and the patient groups selected (general population or special patient subgroups). The prevalence is 1-8.7% in autopsies and 0.5-4.4% in radiological series. Heterogenity of studies, relatively small number of cases included and the absence of long term follow-up evaluations lead to imprecisions in diagnosis and management of adrenal incidentalomas. In this study, we aimed to evaluate the clinical features, hormonal statuses, features of imaging modalities, managements and histologic diagnoses of 523 patients with adrenal incidentalomas retrospectively during a period of 3 years. Among all cases, 354 (67.7%) were females and 169 (32.3%) were males with a mean age of 55.70 years (±11.29). When our patients were evaluated according to hormonal status, 77.2% (n:404) were hormonally nonfunctional; 13.0% (n:68) had Cushing syndrome, 6.1% (n:32) pheochromocytoma and 3.6% (n:19) primary hyperaldosteronism. When the data concerning computed tomography, which is the main imaging modality of adrenal incidentalomas, were evaluated, 40.9% (n:178) of the lesions were in the right side and 43.7% (n:190) were in the left. There was no significant side predilection. The mean mass size was detected to be 30 mms. When four groups were compared in terms of mass size, the ones in pheochromocytomas were larger and in primary hyperaldosteronism were smaller than the others. Most of the masses were adenomatous (79.7%) in nature and mean Hounsfield unit was -1.50 (±17.72 ). Out of 523 patients recruited to the study, 358 (68.4%) were followed up, 141 (27%) underwent surgery, 3 (0.6%) were on medical therapy and 21 (4%) were lost to follow-up. Among 141 patients who had undergone surgery 45 had nonfunctional adenoma, 50 had Cushing syndrome, 31 had pheochromocytoma, and 15 had primary hyperaldosteronism. When the pathologic specimens of operated patients were evaluated, the pathological diagnosis were reported to be benign adenomas in 78. Adrenocortical carcinoma was detected in 1.7% (n:9) of patients. During the follow-up, the course of disease was stable in 351 patients (67.1%), remissions occured in 117 patients (22.4%), 44 patients (8.4%) were lost to follow-up and the disease recurred in 11 patients (2.1%). In conclusion, our study showed that, adrenal masses should be evaluated due to the possibility of malignancy. Moreever, endocrine evaluation of adrenal incidentalomas can lead to the identification and treatment of a remarkable number of hormonal active lesions.
The serendipitous discovery of adrenal masses during evaluation and treatment of clinical status unrelated to adrenal disease are defined as incidentalomas. The adrenal masses detected during staging and follow-up of malignancies are not included into this definition. This subject increasingly draws attention because of the increased incidence of adrenal masses by aging and widespread use of imaging modalities due to various causes. The prevalence of adrenal incidentalomas vary according to the source of data collection (autopsy and radiologic series) and the patient groups selected (general population or special patient subgroups). The prevalence is 1-8.7% in autopsies and 0.5-4.4% in radiological series. Heterogenity of studies, relatively small number of cases included and the absence of long term follow-up evaluations lead to imprecisions in diagnosis and management of adrenal incidentalomas. In this study, we aimed to evaluate the clinical features, hormonal statuses, features of imaging modalities, managements and histologic diagnoses of 523 patients with adrenal incidentalomas retrospectively during a period of 3 years. Among all cases, 354 (67.7%) were females and 169 (32.3%) were males with a mean age of 55.70 years (±11.29). When our patients were evaluated according to hormonal status, 77.2% (n:404) were hormonally nonfunctional; 13.0% (n:68) had Cushing syndrome, 6.1% (n:32) pheochromocytoma and 3.6% (n:19) primary hyperaldosteronism. When the data concerning computed tomography, which is the main imaging modality of adrenal incidentalomas, were evaluated, 40.9% (n:178) of the lesions were in the right side and 43.7% (n:190) were in the left. There was no significant side predilection. The mean mass size was detected to be 30 mms. When four groups were compared in terms of mass size, the ones in pheochromocytomas were larger and in primary hyperaldosteronism were smaller than the others. Most of the masses were adenomatous (79.7%) in nature and mean Hounsfield unit was -1.50 (±17.72 ). Out of 523 patients recruited to the study, 358 (68.4%) were followed up, 141 (27%) underwent surgery, 3 (0.6%) were on medical therapy and 21 (4%) were lost to follow-up. Among 141 patients who had undergone surgery 45 had nonfunctional adenoma, 50 had Cushing syndrome, 31 had pheochromocytoma, and 15 had primary hyperaldosteronism. When the pathologic specimens of operated patients were evaluated, the pathological diagnosis were reported to be benign adenomas in 78. Adrenocortical carcinoma was detected in 1.7% (n:9) of patients. During the follow-up, the course of disease was stable in 351 patients (67.1%), remissions occured in 117 patients (22.4%), 44 patients (8.4%) were lost to follow-up and the disease recurred in 11 patients (2.1%). In conclusion, our study showed that, adrenal masses should be evaluated due to the possibility of malignancy. Moreever, endocrine evaluation of adrenal incidentalomas can lead to the identification and treatment of a remarkable number of hormonal active lesions.
Description
Keywords
Adrenal insidentaloma, Adrenokortikal karsinom, Cushing sendromu, Feokromositoma, Primer hiperaldosteronizm, Adrenal incidentaloma, Adrenocortical carcinoma, Cushing syndrome, Pheochromocytoma, Primary hyperaldosteronism
Citation
Peynirci, H. (2015). Adrenal insidentalomalı hastaların klinik, laboratuvar ve radyolojik özelliklerinin retrospektif olarak değerlendirilmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.