一例不同组织来源的双侧肾上腺肿瘤并文献分析  

Bilateral adrenal tumors from different tissues： 1 case report and literature review

作　　者：张玉石[1] 李汉忠[1] 肖剑春[1] 周毅[1] 周智恩[1] 童安莉[2] 

机构地区：[1]中国医学科学院北京协和医院泌尿外科,北京100730 [2]中国医学科学院北京协和医院内分泌科,北京100730

出　　处：《中华内分泌外科杂志》2012年第3期179-181,187,共4页Chinese Journal of Endocrine Surgery

摘　　要：目的提高对不同组织来源的双侧肾上腺肿瘤的认识，探讨其诊治方法。方法回顾性分析中国医学科学院北京协和医院泌尿外科收治的1例双侧肾上腺分别患嗜铬细胞瘤和库欣腺瘤患者的症状、体征、辅助检查及诊治经过等资料。结果患者因脸变圆红于外院诊断为非促肾上腺皮质激素（adrenocorticotropic hormone，ACTH）依赖性皮质醇增多症，右肾上腺肿瘤，行腹腔镜右肾上腺肿瘤切除，术中血压升高，病理诊断为嗜铬细胞瘤。术后皮质醇增多症状未缓解，复查血ACTH〈5pg／ml，24h尿游离皮质醇（urinary-free cortisol，UFC）571．32μg；24h尿儿茶酚胺：去甲肾上腺素22．80μg，肾上腺素2．55μg，多巴胺92．92μg；CT示左肾上腺肿瘤。诊断为库欣综合征，左。肾上腺肿瘤，右肾上腺嗜铬细胞瘤术后。转入中国医学科学院北京协和医院行腹腔镜左肾上腺肿瘤切除术，术后病理：肾上腺皮质腺瘤。术后1周复查UFC56．2μg。结论不同组织来源的双侧肾上腺肿瘤可以发生，但罕见，治疗应选择双侧肿瘤切除，并保留部分肾上腺组织。Objective To improve the recognization of bilateral adrenal tumors from different tissues and to discuss the treatment. Methods One case of bilateral adrenal tumors from different tissues ： pheochromocytoma in one side and adrenocortical adenoma in the other side was reported and the data of syptoms, physical features, auxiliary examination, diagnosis and treatment were retrospectively reviewed. Results The patient was diagnosed as adrenocorticotropic hormone （ACTH）-independent Cushing＇s syndrome in other hospital and received laparoscopic adrenalectomy for right adrenal tumor. During the operation the blood pressure fluctuated seriously and was even more than 200 mm Hg. The pathological report showed the mass was pheochromocytoma. After the operation, the patient＇s clinical manifestation was not changed. Half a year later the lab test showed blood ACTH was still less than 5 pg/ml, 24 h urinary-free cortisol （UFC） was 571.32 μg, and 24 h urinary catecholamines （UCA） was： noradrenalin （NE） 22. 80 μg, epinephrine （E） 2.55μg, dopamine （DA） 92.92 μg. CT detected a mass in left adrenal gland. The patient received laparoscopic adrenalectomy for left adrenal tumor after being transferred to Peking Union Medical College Hospital. The tumor was proved as adrenocortical adenoma by postoperational pathology. One week after the operation, the 24 h UFC was 56. 2 μg. Conclusions Bilateral adrenal tumors from different tissues are very rare in clinic. Adrenalectomy for tumors from both sides and remaining the normal adrenal glands are recommended.

关 键 词：双侧.肾上腺肿瘤 嗜铬细胞瘤 库欣综合征 组织学 

分 类 号：R736.6[医药卫生—肿瘤]