腎上腺腫瘤切除術的十年經驗

李齊泰^1,2，張景欣^1,2

¹臺北醫學大學附設醫院泌尿科,²臺北醫學大學泌尿腎臟研究中心

Decade of Experience with Adrenalectomy for Adrenal Neoplasms: Clinical Insights and Outcomes

Chitai Li^1,2 , Ching-Hsin Chang^1,2

¹Department of Urology, Taipei Medical University Hospital, Taipei, 11031, Taiwan

²TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei, 11031, Taiwan

Purpose: Primary aldosteronism has emerged as a prevalent cause of hypertension. To diagnose aldosterone-producing adenomas (APAs), the Mayo Clinic developed an algorithm that incorporates adrenal computed tomography (CT) and adrenal vein sampling (AVS). This study aims to review our outcomes of adrenalectomy over a decade.

Materials and Methods: This retrospective chart review was conducted with strict data handling protocols, including de-identification and secure data management. Comprehensive data were collected and analyzed, covering initial symptoms, 24-hour urine tests, imaging studies, AVS results, surgical outcomes, and follow-up duration.

Results: Between October 2014 and October 2024, 184 patients underwent adrenalectomy, including 12 cases of pheochromocytoma, 3 cases of adrenal cortical carcinoma, and 3 cases of metastatic malignancy. Nuclear medicine NP-59 scans were conducted for 42 patients, although 12 scans yielded equivocal results. A total of 95 patients underwent AVS for diagnostic purposes. The mean follow-up period was 41.52 ± 36.05 months.

The cohort comprised 86 males and 98 females, with a mean age of 55.02 ± 13.20 years. Preoperative imaging identified 21 patients with radiologically unremarkable tumors and 16 with tumors less than 1 cm in diameter. Pathology of benign tumors revealed adrenal cortical adenoma (76%), adrenal hyperplasia (19%).

Conclusions: Over the past decade, NP-59 scan and AVS have been instrumental in guiding surgical decision-making, particularly for patients with radiologically inconspicuous finding.