双侧肾上腺病变的病因分布谱及临床表现分析  

Analysis of etiology distribution and clinical manifestation in bilateral adrenal lesions

作　　者：史佳乐 杨琴[1] 曾庆莲 张莹宵 程庆丰[1] 杜志鹏[1] Shi Jiale;Yang Qin;Zeng Qinglian;Zhang Yingxiao;Cheng Qingfeng;Du Zhipeng(Department of Endocrinology,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院内分泌科,重庆400016

出　　处：《中华内分泌外科杂志》2022年第6期685-688,共4页Chinese Journal of Endocrine Surgery

摘　　要：目的探讨双侧肾上腺病变的病因分布和临床特点。方法收集2013年1月至2018年3月于重庆医科大学附属第一医院住院诊治的143例双侧肾上腺病变患者的临床资料,进行回顾性分析。结果140例患者被纳入最终分析,其中男性79例,女性61例,就诊年龄(51.53±13.93)岁。病因分布方面,居于首位的是原发性醛固酮增多症44例(31.43%),其次为库欣综合征27例(19.29%),无功能性病变23例(16.43%),肾上腺结核17例(12.14%),嗜铬细胞瘤11例(7.86%),先天性肾上腺皮质增生症5例(3.57%),肾上腺转移癌5例(3.57%),肾上腺淋巴瘤4例(2.86%)。根据病灶大小分成≤2 cm,2~4 cm和≥4 cm 3组,在各组中分别观察到原发性醛固酮增多症(62.79%),库欣综合征(46.15%)和嗜铬细胞瘤(31.25%)所占比例最高。从瘤体直径角度比较,嗜铬细胞瘤最大,其次为库欣综合征、无功能性病变、原发性醛固酮增多症,4者瘤体直径差异有统计学意义。结论本院影像学表现为双侧肾上腺病变的患者,原发性醛固酮增多症和库欣综合征多于无功能性病变。病灶大小对于内分泌病因诊断及肿瘤性质的鉴别具有参考价值。影像学表型有助于判断肿瘤类型。Objective To investigate the etiologies and clinical characteristics of bilateral adrenal lesions.Methods The clinical data of 143 patients with bilateral adrenal lesions hospitalized in the First Affiliated Hospital of Chongqing Medical University from Jan.2013 to Mar.2018 were collected and analyzed.Results 140 patients were retained for final analysis.79 were men,and 61 were women.The age was(51.53±13.93)years.Regarding the etiologies,there were primary aldosteronism(n=44,31.43%),Cushing’s syndrome(n=27,19.29%),non-functional lesions(n=23,16.43%),adrenal tuberculosis(n=17,12.14%),pheochromocytoma(n=11,7.86%),congenital adrenal hyperplasia(n=5,3.57%),adrenal metastases(n=5,3.57%),and adrenal lymphoma(n=4,2.86).These patients were classified into the following groups according to the mass size:≤2 cm,2-4 cm and≥4 cm.The highest proportion of primary aldosteronism(62.79%),Cushing’s syndrome(46.15%)and pheochromocytoma(31.25%)was observed in the≤2 cm,2-4 cm and≥4 cm groups,respectively.The mass sizes of primary aldosteronism,Cushing’s syndrome and pheochromocytoma were compared,with pheochromocytoma the largest,followed by Cushing’s syndrome,non-functional lesion,and primary aldosteronism.Conclusions For patients with bilateral adrenal lesions in our hospital,primary aldosteronism and Cushing’s syndrome are more common than non-functional lesion.Mass size is of great value in the diagnosis of endocrinological etiology,as well as distinguishing malignant tumors from the benign ones.The imaging phenotype is helpful to determine tumor types.

关 键 词：肾上腺肿瘤 原发性醛固酮增多症 库欣综合征 嗜铬细胞瘤 

分 类 号：R586[医药卫生—内分泌]