腹部CT检查发现的939例肾上腺病变患者的临床分析

发布时间：2018-04-24 02:40

本文选题：肾上腺病变 + 肾上腺意外瘤　；参考：《南方医科大学学报》2017年08期

【摘要】：目的探讨腹部CT检查发现的肾上腺病变的检出率、病因构成、临床特点及诊治现状。方法回顾性分析2014年7月~2015年6月于南方医科大学南方医院影像中心行腹部CT检查报告提示肾上腺有异常改变的门诊和住院患者的病历资料,包括患者性别、年龄、影像特征、生化检验、临床诊断、治疗方式、术后病理、发现病变的原因等。结果(1)本院1年内行腹部CT检查的患者共19 004例,检查提示存在肾上腺病变的患者共939例,检出率为4.9%。其中男性560例(59.6%),女性379例(40.4%),平均就诊年龄为53.2岁。肾上腺占位在总体肾上腺病变中所占比例随年龄递增呈有上升趋势。行内分泌功能评估的患者有270例(28.8%),无功能性病变占38.9%,功能性病变中原发性醛固酮增多症比例最高,占16.3%;库欣综合征和亚临床库欣综合征各占4.1%和7.0%;嗜铬细胞瘤占7.0%。(2)共发现肾上腺意外瘤191例,检出率为1.0%,其中良性腺瘤占70.3%,肾上腺皮质癌和肾上腺转移癌的比例分别为2.4%和0.5%。只有76例(39.8%)患者进行了内分泌功能评估,其中无功能瘤34例,占44.7%;功能性病变以嗜铬细胞瘤最常见,占22.4%,而原发性醛固酮增多症和亚临床库欣综合征各占9.2%和6.6%。结论我院所有腹部CT检查中肾上腺病变的检出率达4.9%,肾上腺意外瘤的检出率1.0%。虽然大多数肾上腺病变为良性无功能病变,但仍有部分具有内分泌功能或为恶性病变。临床上约有60%的肾上腺意外瘤患者未进行内分泌功能的评估,功能亢进的病变极易被漏诊。临床医生需要进一步提高对肾上腺意外瘤的认识并规范其诊疗流程。
[Abstract]:Objective to investigate the detection rate, etiology, clinical features, diagnosis and treatment of adrenal lesions detected by abdominal CT. Methods from July 2014 to June 2015, the medical records of outpatients and inpatients with abnormal changes of adrenal gland, including gender, age and imaging features, were analyzed retrospectively in the imaging center of Southern Hospital of Southern Medical University. Biochemical examination, clinical diagnosis, treatment, postoperative pathology, cause of finding pathological changes, etc. Results 1) A total of 19 004 patients underwent abdominal CT examination within one year in our hospital, 939 of whom were found to have adrenal lesions, and the detection rate was 4.9%. Among them, 560 cases were male, 59.6%, 379 cases were female, the average age was 53.2 years. The proportion of adrenal mass in the total adrenal lesions increased with age. 270 patients with endocrine function were assessed, and non-functional lesions accounted for 38.9. The proportion of primary aldosteronism was the highest in functional lesions. The proportion of Cushing's syndrome and subclinical Cushing's syndrome were 4.1% and 7.0%, respectively; the proportion of pheochromocytoma was 7.0%.) 191 cases of adrenal accidental tumor were found, and the detection rate was 1.0%. The proportion of benign adenoma was 70.3%, the proportion of adrenal cortical carcinoma and adrenal metastatic carcinoma was 2.4% and 0.5%, respectively. Only 76 patients (39.8%) were assessed for endocrine function, 34 cases (44.7%) were nonfunctional tumors, the most common functional lesions were pheochromocytoma (22.442%), while primary aldosteronism and subclinical Cushing syndrome accounted for 9.2% and 6.6%, respectively. Conclusion the detection rate of adrenal lesions in all abdominal CT scans is 4.9 and that of adrenal accidental tumors is 1.0%. Although most adrenal lesions are benign and nonfunctional, some are endocrine or malignant. Clinically, about 60% of adrenal accidental tumor patients have not been assessed for endocrine function, hyperfunctional lesions are easy to be missed. Clinicians need to further improve their understanding of adrenal accidental tumors and standardize their diagnosis and treatment procedures.
【作者单位】：南方医科大学南方医院内分泌代谢科;南方医科大学南方医院影像中心;
【基金】：国家自然科学基金(31400992,81470047)~~
【分类号】：R586;R736.6

【参考文献】