摘要
目的探讨术前未能确诊的肾上腺意外瘤(AI)中嗜铬细胞瘤的临床特点。方法回顾性分析2012年3月-2016年12月在解放军总医院就诊的AI患者中经病理确诊的103例肾上腺嗜铬细胞瘤资料。根据术前内分泌科诊断分为两组:术前诊断为无功能瘤(A组)16例;术前诊断为嗜铬细胞瘤(B组)87例。分析两组间临床表现、内分泌激素水平及影像学检查结果。结果 A组高血压诊断年龄(55.5±9.09岁)明显大于B组(43.61±12.30岁),差异有统计学意义(P<0.05)。两组性别、年龄、血压等一般临床特点差异无统计学意义。A组尿儿茶酚胺(CA)升高比率达88.9%,与B组(95.1%)比较差异无统计学意义,尿CA升高2倍比率、尿多巴胺值、肿瘤最大径及MRI阳性率明显低于B组(P<0.05)。随着肿瘤最大径的增大,诊断嗜铬细胞瘤的比例也逐渐增高(P<0.01)。间碘苄胍显像、生长抑素受体显像和正电子发射断层扫描在B组的阳性率分别为87.5%、66.7%和80.0%。结论 AI中嗜铬细胞瘤的诊断不应忽视高血压患病年龄大的患者,对于尿CA高于正常上限的患者应予以高度关注,必要时可结合间碘苄胍显像、生长抑素受体显像及应用示踪剂的PET/CT等功能影像学检查明确诊断。
Objective To discuss the clinical features of preoperative undiagnosed pheochromocytoma in patients with adrenal incidentaloma（AI）. Methods The clinical data were retrospectively analyzed of 103 cases of pathologically diagnosed adrenal pheochromocytoma in patients with AI admitted in the General Hospital of Chinese PLA during Mar. 2012 to Dec. 2016. The cases were divided into two groups： patients preoperatively diagnosed as non-function adrenal tumor were assigned as group A（n=16）, and preoperatively diagnosed as pheochromocytoma were assigned as group B（n=87）. The clinical features, endocrine hormone levels and imaging features of the two groups were analyzed. Results The age when diagnosed as hypertension was higher in group A（55.5±9.1 years） than in group B（43.6±12.3 years, P〈0.05）. No significant difference existed between the two groups on sex, age, blood pressure and general clinical features. The urinary positive rate of catecholamine（CA） showed no statistical significance between group A（88.9%） and group B（95.1%）, but the ratio of urinary CA increasing by 2 times, the urinary dopamine, the maximum diameter of tumor and the positive rate of MRI were lower in group A than in group B（P〈0.05）. Along with the increase of maximum diameter of tumor, the diagnostic ratio of pheochromocytoma also increased（P〈0.01）. The positive rate of metaiodobenzyl guanidine（MIBG）, somatostatin receptor imaging and positron emission tomography（PET/CT） were respectively 87.5%, 66.7% and 80.0% in group B. Conclusions For improving the diagnosis of pheochromocytoma in AI, the older patients with hypertension should not be ignored, and those patients with higher CA than the upper limit should be paid more attention. If necessary, the functional imaging may be used to confirm the diagnosis such as MIBG, somatostatin receptor imaging and PET/CT applying radiotracers.
作者
刘颖姝
李乐乐
窦京涛
汪保安
刘丹丹
杜锦
杨国庆
臧丽
王先令
巴建明
吕朝晖
高政南
母义明
LIU Ying-shu;LI Le-le;DOU Jing-tao;WANG Bao-an;LIU Dan-dan;DU Jin;YANG Guo-qing;ZANG Li;WANG Xian-ling;BAJian-ming;LV Zhao-hui;GAO Zheng-nan;MU Yi-ming(Department of Endocrinology,Chinese PLA General Hospital,Beijing 100853,China;Department of Endocrinology,Dalian Municipal Central Hospital,Dalian,Liaoning 116021,China;Department of Endocrinology and Genetic Metabolism,Beijing Children＇s Hospital,Capital Medical University,National Center for Children＇s Healthj Beijing 100045,China;Department of Endocrinology,Hainan Branch of Chinese PLA General Hospitaly Sanyaj Hainan 572013,China)
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2018年第7期559-563,共5页
Medical Journal of Chinese People's Liberation Army
关键词
肾上腺意外瘤
嗜铬细胞瘤
尿儿茶酚胺
肿瘤最大径
adrenal incidentaloma
pheochromocytoma
urinary catecholamine
maximum diameter of tumor
