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Adrenal kortikal tümörlerde klinik, radyolojik, patolojik değişkenlerin karşılaştırılması

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  1. Tez No: 933187
  2. Yazar: İLAYDA FATMA BEKLER ŞEKER
  3. Danışmanlar: PROF. DR. HÜLYA ILIKSU GÖZÜ
  4. Tez Türü: Tıpta Uzmanlık
  5. Konular: Endokrinoloji ve Metabolizma Hastalıkları, Endocrinology and Metabolic Diseases
  6. Anahtar Kelimeler: Adrenal mass, adrenocortical carcinoma, incidentaloma
  7. Yıl: 2025
  8. Dil: Türkçe
  9. Üniversite: Marmara Üniversitesi
  10. Enstitü: Tıp Fakültesi
  11. Ana Bilim Dalı: İç Hastalıkları Ana Bilim Dalı
  12. Bilim Dalı: Belirtilmemiş.
  13. Sayfa Sayısı: 156

Özet

Çalışmamızda Marmara Üniversitesi Tıp Fakültesi Hastanesi'ne, 2014-2024 yılları arasında başvuran ve adrenal kortikal kitle tespit edilip, opere edilmeden izlenen 259 hasta ve opere edilerek izlenen 143 hasta alınmıştır. Adrenokortikal kitleler; klinik, radyolojik, patolojik ve fonksiyonel özelliklerine göre (non-fonksiyone adenom, Cushing sendromu, Conn sendromu) göre karşılaştırılmıştır. Hem opere hem non-opere adrenokortikal kitleler kadın cinsiyet (opere %62.5 ; non-opere %60.8) ve orta-ileri yaşta (59,22 ± 12,09) daha sık görülmüştür. Opere grupta ortalama yaş (49,76±11,55 yaş); non-opere gruba (55,53±10,98) göre daha düşük saptanmıştır (p =0,001; p

Özet (Çeviri)

In our study, 259 patients with adrenal cortical masses who were monitored without surgery and 143 patients who underwent surgery at Marmara University Faculty of Medicine Hospital between 2014 and 2024 were included. Adrenocortical masses were compared based on their clinical, radiological, pathological, and functional characteristics (non-functioning adenoma, Cushing's syndrome, Conn's syndrome). Both operated and non-operated adrenocortical masses were more frequently observed in female patients (operated 62.5%; non-operated 60.8%) and in middle-to-advanced age groups (mean age: 59.22 ± 12.09 years). The mean age in the operated group (49.76 ± 11.55 years) was significantly lower than in the non-operated group (55.53 ± 10.98 years) (p = 0.001; p < 0.01). In both groups, non-functioning adenomas were the most common type (non-operated: n=218, 84.2%; operated: n=100, 69.9%). Among hormonally active masses, surgical intervention was more frequently performed in patients with Conn's syndrome compared to those with Cushing's syndrome (p = 0.008). Regarding presenting symptoms, patients in the operated group were more symptomatic. Abdominal pain (non-operated: 4.6%; operated: 11.9%; p = 0.007), flank pain (non-operated: 2.7%; operated: 10.5%; p = 0.001), and Cushingoid features (non-operated: n=10, 3.9%; operated: n=20, 14%; p = 0.001) were significantly more common. The operated group had an earlier diagnosis of hypertension (p = 0.001), and the prevalence of depression was also higher (p = 0.009; p < 0.01). The 1 mg dexamethasone suppression test (DST) results were significantly higher in the operated group compared to the non-operated group (p < 0.001). Tumor size was also significantly larger in the operated group (39.65 ± 31.48 mm) than in the non-operated group (23.56 ± 11.56 mm) (p = 0.001; p < 0.01). Magnetic resonance imaging (MRI) findings demonstrated that lesions with high fat density were more frequently observed in the non-operated group (p = 0.002).Among the operated cases, the majority were diagnosed with adrenocortical adenoma (n=81, 56.6%). The Weiss score of adrenal adenomas (0.23 ± 0.66) was significantly lower compared to adrenal neoplasia (1.33 ± 1.37) and adrenocortical carcinoma (3.63 ± 2.41) (p = 0.001; p = 0.014; p < 0.05). In the non-operated group, patients with Cushing's syndrome had a significantly higher prevalence of osteoporosis (n=8, 22.2%) compared to those with non-functioning adenomas (n=17, 7.8%) (p = 0.007; p < 0.01). In contrast, patients with Conn's syndrome had a significantly higher prevalence of hypertension compared to those with Cushing's syndrome (p = 0.001; p < 0.01). Similarly, in the operated group, osteoporosis was significantly more frequent in patients with Cushing's syndrome (n=10, 37.4%) compared to those with Conn's syndrome (n=1, 6.3%) and non-functioning adenomas (n=10, 10%) (p = 0.001; p = 0.025; p < 0.05).In the non-operated group, dexamethasone suppression test (DST) results were significantly higher in patients with Cushing's syndrome compared to those with non-functioning adenomas and Conn's syndrome (p = 0.001; p = 0.014; p < 0.05). Similarly, aldosterone levels were significantly higher in patients with Conn's syndrome compared to those with Cushing's syndrome and non-functioning adenomas (p = 0.025; p = 0.004; p < 0.05). In the operated group, potassium levels were significantly lower in patients with Conn's syndrome compared to those with non-functioning adenomas and Cushing's syndrome (p = 0.005; p = 0.010; p < 0.05). The most significant laboratory parameter influencing the surgical decision, as demonstrated by both univariate and multivariate analyses, was the 1 mg DST result (univariate: OR = 1.17, p < 0.001; multivariate: OR = 1.25, p < 0.001). Tumor size was also a significant determinant for surgical intervention in both analyses (univariate: OR = 1.04, p < 0.001; multivariate: OR = 1.04, p < 0.001). In univariate analysis, histological features such as atypical mitosis (OR = 15.5, p = 0.001), capsular invasion (OR = 12.3, p < 0.001), vascular invasion (OR = 9.19, p = 0.001), necrosis (OR = 8.32, p < 0.001), and lymphatic invasion (OR = 7.27, p = 0.005) were identified as significant risk factors for malignancy. However, these findings did not retain significance in multivariate analysis. When adrenal cortical masses are detected, clinical, biochemical, and radiological characteristics should be carefully evaluated to determine their functional status and malignant potential. The decision for surgical intervention or clinical follow-up should be based on these factors.

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