Klinička prezentacija slučajno otkrivenih tumora nadbubrega ‒ naša iskustva
Sažetak
Uvod/Cilj. Incidentalomi nadbubrega su tumori nadbubrežne regije koji su slučajno otkriveni različitim radiološkim ispitivanjima, u toku dijagnostike oboljenja koja nisu povezana sa adrenalnom patologijom. Cilj rada je bio da se analiziraju kliničke, biohumoralne i histopatološke karakteristike adrenalnih incidentaloma. Metode. Retrospektivnom analizom bilo je obuhvaćeno 85 bolesnika (32 muškarca i 53 žena), koji su ispitivani na Klinici za endokrinologiju Vojnomedcinske akademije u Beogradu, u periodu od januara 2013. do decembra 2017. godine zbog incidentaloma nadbubrega. Ispitivani su životno doba bolesnika, veličina lokalizacija i funkcionalna aktivnost tumora, kao i postojanje komorbiditeta. Adrenalektomija je učinjena kod 35 bolesnika na osnovu tumorske veličine, hormonske aktivnosti i pridruženih bolesti. Rezultati. Najveći broj (56,4%) adrenalnih tumora otkriven je ultrazvučnim pregledom abdomena, kod 23 (27,2%) bolesnika putem kompjuterizovane tomo
grafije (CT) abdomena, kod 13 (15,2%) bolesnika putem CT pregleda grudnog koša i kod 1 (1,2%) bolesnika pomoću magnetne rezonance abdomena. Prosečna veličina tumora iznosila je 3,8 ± 2,3 cm (raspon od 1 do 15 cm). Adrenalni tumori su bili bilateralni kod 23% bolesnika, kod 46% bolesnika su bili lokalizovani u desnom, a u 31% slučajeva u levom nadbubregu. Supklinički hiperkorticizam, definisan kao neadekvatna kortizolska supresija prekonoćnim deksametazonskim testom (1 mg) uočena je kod 34 (40%) bolesnika, dok je odsustvo kortizolske supresije (autonomna kortizolska sekrecija) pronađena kod 4 (4.7%) bolesnika. U preostalih 47 (55.3%) bolesnika ostvarena je kompletna prekonoćna supresija deksametazonom. Adrenelektomija je učinjena kod 35 (41%) bolesnika, među kojima je kod njih 4 (11,4%) dijagnostikovan adrenokortikalni karcinom, kod 15 (42,9%) adenomi, feohromocitom kod 4 (11,4%), nodularna hiperplazija kod 5 (14,3%), udaljena metastaza kod jednog (2,8%), dok se kod preostalih bolesnika radilo o različitim benignim masama. Zaključak. Kod bolesnika sa incidentalno uočenim tumorima nadbubrežne regije trebalo bi razjasniti dva osnovna pitanja: funkcionalni status tumora i/ili prisustvo maligniteta. Kod svih bolesnika bi trebalo sprovesti biohumoralno ispitivanje u smislu autonomne ili moguće autonomne kortizolske sekrecije, kao i ispitivanje autonomnog adrenergičnog i mineralokortikoidnog ekscesa. Kod svih bolesnika kod kojih postoji dokaz o autonomnoj sekreciji bilo kojeg hormona, neophodno je sprovesti radikalno lečenje, nezavisno od prisustva ili odsustva tipične kliničke manifestacije.
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