Conservative and surgical management of incidentally discovered adrenal tumors (incidentalomas)
Autor: | F. Jockenhövel, W. Reinhardt, Georg Benker, S. Lederbogen, D. Reinwein, Th. Olbricht, B. P. Hauffa, W. Kuck |
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Rok vydání: | 1992 |
Předmět: |
Adult
Male medicine.medical_specialty Endocrinology Diabetes and Metabolism Adrenal Gland Neoplasms Malignancy Metastasis Endocrinology Adrenal Cortex Hormones medicine Humans Neoplasm Endocrine system Congenital adrenal hyperplasia Neoplasm Metastasis Aged Subclinical infection business.industry Adrenal gland Incidentaloma Adrenalectomy Middle Aged medicine.disease Surgery medicine.anatomical_structure Female Adrenal Cortex Function Tests Radiology business |
Zdroj: | Journal of Endocrinological Investigation. 15:331-337 |
ISSN: | 1720-8386 0391-4097 |
DOI: | 10.1007/bf03348745 |
Popis: | Of 50 patients with incidentalomas (INC), 18 were adrenalectomized and in 18 patients the INC was left in place. For 14 patients clinical data were insufficient for evaluation. Follow-up investigation of the 18 unoperated subjects 11-101 months (median 32.2) after the diagnosis had been made revealed unchanged size of the INC [initially 2.1 +/- 0.8 cm (mean +/- SD) at follow-up 2.0 +/- 1.0 cm]. Cushing's syndrome developed in one patient, which was not evident at the initial discovery of the INC 32 months before. "Pre-Cushing's Syndrome" was detected in 1 patient and confirmed in a second who had displayed a pathologically high dose dexamethasone suppression test 101 months before. In addition, 3 male patients with a hitherto unknown mild subclinical defect of 21-hydroxylase activity were identified. The remaining 12 patients had normal endocrine activity of their adrenals. Eighteen patients were adrenalectomized with an average tumor size of 3.96 +/- 1.88 cm. Histologically, 10 (52%) adenomas were observed, including 3 with signs of hypercortisolism. Adrenal hyperplasias were observed in 2 patients, metastasis in 1 patient. 31.5% of the INC which were removed were nonmalignant tumors of other than adrenal origin. We conclude that initially endocrinologically inactive adrenal tumors can eventually develop autonomous endocrine activity and therefore need to be reexamined at regular intervals. Conservative management with regular follow-up investigations is the preferable treatment for small incidentalomas when endocrine over-activity has been excluded and no indications of malignancy exist. Based on these observations and the literature a diagnostic and therapeutic strategy is presented. |
Databáze: | OpenAIRE |
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