肾上腺意外瘤的评估

肾上腺意外瘤通常在肾和肾上腺的影像学检查时被发现。它们分为有功能或无功能型，恶性或良性。需要生化和影像学评估来确定分型。[1]Grumbach MM, Biller BM, Braunstein GD, et al. Management of the clinically inapparent adrenal mass ("incidentaloma"). Ann Intern Med. 2003;138:424-429.http://www.annals.org/cgi/content/full/138/5/424http://www.ncbi.nlm.nih.gov/pubmed/12614096?tool=bestpractice.com肾上腺肿瘤是人类最常见的肿瘤之一。临床上不明显的肾上腺肿块的患病率随年龄增长而增高，年龄小于 30 岁患者的患病率＜1%，70 岁及 70 岁以上患者的患病率达 7%。[1]Grumbach MM, Biller BM, Braunstein GD, et al. Management of the clinically inapparent adrenal mass ("incidentaloma"). Ann Intern Med. 2003;138:424-429.http://www.annals.org/cgi/content/full/138/5/424http://www.ncbi.nlm.nih.gov/pubmed/12614096?tool=bestpractice.com

病因学的患病率数据显示，41%是腺瘤，19%是转移瘤，10%是肾上腺皮质癌，9%是脂肪瘤，肾上腺内的嗜铬细胞瘤高达8%，剩余的其他大部分是良性肿瘤（囊肿、肾上腺脂肪瘤、血肿、平滑肌瘤、淋巴管瘤）。[2]Agency for Healthcare Research and Quality. Management of clinically inapparent adrenal mass. Evidence Report/Technology Assessment: No. 56 AHRQ Publication No. 02-E013. February 2002. http://www.ahrq.gov (last accessed 9 September 2017).http://archive.ahrq.gov/clinic/tp/adrentp.htm[3]Kloos RT, Gross MD, Francis IR, et al. Incidentally discovered adrenal masses. Endocr Rev. 1995;16:460-484.http://www.ncbi.nlm.nih.gov/pubmed/8521790?tool=bestpractice.com

根据尸检结果，肾上腺腺瘤的患病率为 6%，根据腹部 CT 为 4%。[4]Young WF Jr. Clinical practice. The incidentally discovered adrenal mass. N Engl J Med. 2007;356:601-610. 大部分导致库欣综合征、嗜铬细胞瘤或原发性高醛固酮症的具有激素活性的肾上腺肿瘤为良性，罕见情况可能为恶性。然而，肾上腺皮质癌，虽然罕见，但往往是有激素活性的。