Şafak AKIN, Selçuk DAĞDELEN, Okan Bülent YILDIZ, Alper GÜRLEK, Tomris ERBAŞ, Miyase BAYRAKTAR

İNSİDENTAL ADRENAL LEZYONLARIN KLİNİK, HORMONAL VE HİSTOLOJİK DEĞERLENDİRİLMESİ: TEK MERKEZ SONUÇLARI

AMAÇ: Adrenal insidentaloma günümüzde radyolojik görüntüleme yöntemlerinin yaygın kullanılmasıyla beraber klinikte sıkça karşılaştığımız bir problemdir. Bu çalışmada adrenal insidentaloma (Aİ) tanılı hastaların genel özelliklerinin değerlendirilmesi amaçlanmıştır.GEREÇ VE YÖNTEM: Çalışmada 2001-2013 yılları arasında Hacettepe Üniversitesi Tıp Fakültesi Hastanesi’nde Aİ tanısı alıp takip edilen hastaların klinik ve laboratuvar sonuçları retrospektif olarak incelenmiştir.BULGULAR: Çalışmaya 543 hasta dahil edildi. Hastaların 315 (%58)’ i kadın, 228 (%42)’ i erkekti (p<0.001). Ortalama tanı yaşı 56.71 ± 11.79 yıl idi. Fonksiyonel değerlendirmesi tam yapılan hastaların %76.2’si fonksiyonsuz adenom, %11.4’ü feokromositoma, %9.9’u subklinik Cushing sendromu (SCS), %1.6’si Cushing sendromu, %0.5’i hiperaldosteronizm ve %0.5’i katekolamin, glukokortikoid, mineralokortikoid ve androjen yüksekliği vakası idi. Yüzsekiz adrenalektomi yapılan hastanın, 28 (%26)’i adrenokortikal adenom, 15 (%14)’i feokromasitoma, 14 (%13)’ü adrenokortikal karsinom, ve diğer nadir tümör tipleri idi. Opere olan hastalar, olmayanlardan daha gençti (ortalama yaş, 54; sınırlar, 18-83; vs 57, 27-105 yaş, p < 0.001). Tüm Aİ serisinin ortanca sağ kalımı 101 ay [standart hata (SE): 15.1; %95 güven aralığı: 71.4-130.6] olarak saptandı.SONUÇ: Adrenal insidentaloma toplumda sık görülmektedir ve nispeten basit ve ucuz tanı yöntemlerine ihtiyaç vardır. İlk tanı anında düzgün ve güvenilir tanı testleri ile değerlendirilme yapılmalıdır. Uzun dönemde opere olan ve olmayan hastaların verilerinin karşılaştırıldığı çalışmalara ihtiyaç vardır.

Anahtar Kelimeler:

Adrenal İnsidentaloma, Feokromositoma, Subklinik Cushing Sendromu

SONUÇLARICLINICAL, HORMONAL AND HISTOLOGICAL EVALUATION OF INCIDENTAL ADRENAL LESIONS: SINGLE CENTER RESULTS

OBJECTIVE: Adrenal incidentaloma is a problem that is frequently encountered clinically with the widespread use of radiological imaging methods. In this study, it was aimed to evaluate the general characteristics of patients with adrenal incidentaloma (AI).MATERIAL AND METHODS: Clinical and laboratory results of the patients who were diagnosed and followed up at the Hacettepe University Medical Faculty Hospital between 2001 and 2013 were retrospectively analyzed.RESULTS: 543 patients were included in the study. 315 (58%) of the patients were female and 228 (42%) were male (p <0.001). The mean age at diagnosis was 56.71 ± 11.79 years. Hormonal work-up demonstrated that 76.2% of the masses were non functional adenoma 11.4% were pheochromocytoma, 9.9% were defined as subclinical Cushing’s syndrome (SCS), 1.6% Cushing’s syndrome, 0.5% were hyperaldosteronism and 0.5% patient concomitant secretion of glucocorticoid, mineralocorticoid, androgen, and catecholamines. Adrenalectomy was performed in 108 patients with removal of 28 adrenocortical adenomas (26%), 15 pheochromocytoma (14%), 14 adrenocortical carcinomas (13%) and other less frequent tumor types. Operated patients were younger than the others (mean age, 54; range, 18-83; vs 57, 27-105, p <0.001). The median survival of the entire AI series was 101 months [standard error (SE): 15.1; 95% confidence interval: 71.4-130.6].CONCLUSIONS: Adrenal incidentaloma is common in the community and relatively simple and inexpensive diagnostic methods are needed. At the first diagnosis, evaluation should be made with proper and reliable diagnostic tests. There is a need for studies comparing the data of patients who have been operated and not operated in the long period.

Keywords:

Adrenal incidentaloma, pheochromocytoma, subclinical Cushing’s syndrome,

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