Incidentaloma de supra-renal: manejo diagnóstico e terapêutico

Abstract

RESUMODescrevemos o caso de paciente que apresentou massa em suprarenal direita na ultra-sonografia abdominal durante investigação de dor abdominal, caracterizando um incidentaloma de supra-renal; a tomografia computadorizada confirmou a presença de lesão. A avaliação endócrina detectou perda do ritmo circadiano do cortisol e sua não supressibilidade pela dexametasona, caracterizando síndrome de Cushing. Entretanto, a paciente não apresentava as características clínicas da síndrome, o que sugeriu o diagnóstico de síndrome de Cushing subclínica. A paciente foi submetida a cirurgia laparoscópica para ressecção da glândula adrenal direita cujo diagnóstico anáto-mo-patológico foi de adenoma de supra-renal. Uma nova avaliação do cortisol foi feita após a cirurgia com resultados normais. Pretendemos sugerir neste relato um manejo racional e com baixos custos, dos incidentalomas de supra-renal. (Arq Bras Endocrinol Metab 2000; 44/6: 523-7) Unitermos: Incidentaloma de supra-renal; Adenoma adrenal; Síndrome de Cushing; Síndrome de Cushing subclínica. ABSTRACTWe report a patient who presented a mass in the right adrenal gland during ultra-sound imaging for the investigation of abdominal pain, characterizing an adrenal incidentaloma; computed tomography confirmed the presence of the lesion. Endocrine evaluation detected loss of circadian rhythm of cortisol production and its non suppressibility to dexamethasone testing, characteristics of the presence of Cushing's syndrome. However, the patient did not present typical clinical manifestations, suggesting subclinical Cushing's syndrome. Laparoscopic surgery for ressection of the right adrenal gland was performed with a pathology diagnosis of adrenal adenoma. Normal cortisol levels were found on re-evaluation. We propose in this report a rational and inexpensive management for adrenal incidentalomas.

The value of signal intensity on T1-weighted chemical shift magnetic resonance imaging combined with proton magnetic resonance spectroscopy for the diagnosis of adrenal adenomas

“…Despite the decrease in sensitivity in nodules with a diameter greater than 4.0 cm, the diagnosis by imaging has a major influence on decisions regarding the treatment, given that the behavior of an adrenal nodule in relation to the neighboring structures (morphology), such as compression and invasion, will inform the surgical planning; at many centers, the protocol calls for resection even in the case of adenomas because of the risk of bleeding and the higher incidence of malignancy in such cases (24) . However, there are authors who recommend the follow-up of lesions that are typically benign, are nonfunctioning, and do not meet the criteria for malignancy (24) . Spectroscopy may prove to be an effective method.…”

Síndrome de cushing e hipercortisolismo associado: uma revisão literária / Cushing’s syndrome and hypercortisolism associated: review of literature

“…Brazilian Journal of Development, Curitiba, v.7, n.6, p. 61473-61484 jun. 2021 O adenoma não funcionante de glândula adrenal é a massa adrenal incidental mais comum e na maioria dos casos os tumores silenciosos são formas leves da Síndrome de Cushing 17 .…”