腎上腺偶見瘤的探討

10.6666/ClinMed.202205_89(5).0055

郝立智；吳劭文；蔡宗憲；楊恆幸；吳明瑞；陳建達；簡崇仁；陳昆祥；楊純宜

腎上腺偶見瘤（adrenal incidentaloma） ； 嗜鉻細胞瘤（pheochromocytoma） ； 原發性醛固酮過多症（primary hyperaldosteronism） ； 微創腎上腺切除術（minimally invasive adrenalectomy）

臨床醫學月刊

89卷5期（2022 / 05 / 27）

344 - 353

繁體中文

本篇文章主要是參考自新英格蘭雜誌（NEJM）在2021年4月份發表的一篇有關Adrenal Incidentaloma的內容為基礎做撰寫，從突出的常見臨床問題的病例介紹開始，然後提出支持各種策略的證據，並對正式的指導方針進行回顧。在診斷測試另一種疾病時發現的所有腎上腺腫瘤患者“偶見瘤＂，都應進行生化測試，以檢測是否有嗜鉻細胞瘤和皮質醇分泌過多，血壓高的患者也應進行生化測試，以檢測是否有原發性醛固酮過多症。嗜鉻細胞瘤患者應在術前充分給予α-受體阻斷劑和β-受體阻斷劑治療後再進行腎上腺切除術。輕度自主性皮質醇過多和原發性醛固酮過多症的患者可能會從腎上腺切除術中受益，但治療應個別化。會非功能性腎上腺腫瘤在電腦斷層掃描（computed tomography, CT）計算評估中呈現衰減值10 Hounsfield單位或更少時，並且最大直徑小於4 cm，通常不需介入或長期追踪。所有在影像學上具有不確定特徵的其他腎上腺偶見瘤，都可能需要額外的影像學檢查，包括經由增強顯影的CT、利用化學位移分析進行的核磁共振影像（magnetic resonance imaging, MRI）檢查、利用^(18)F-氟脫氧葡萄糖（8F-fluorodeoxyglucose）進行的正電子放射斷層掃描（positron-emission tomography, PET）或所有這些檢查。這些腎上腺偶見瘤的處理應個別化，並應會診包括由內分泌內外科醫師、麻醉科醫師、病理科醫師和放射科醫師所組成的多學科團隊。

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