tailieunhanh - ENDOCRINE SURGERY - PART 7

Tóm tắt các chiến lược chính đề xuất để đối phó với Incidentalomas thượng thận Đánh giá chức năng Đường kính ngưỡng 6 cm Chức năng vỏ não tiết niệu steroid (khác nhau) và 2 ngày kiểm tra đàn áp dexamethasone liều thấp - | 420 Aron and Kievit Table 2 Simplified Summary of the Main Strategies Proposed to Deal with Adrenal Incidentalomas Functional assessment Assessment of benign malignant nature Author Ref. Cortical function Medullary function Diameter threshold Imaging characteristics Isotope scanning Fine needle aspiration cytology Copeland 1983 26 Urinary steroids various and 2-day low-dose dexamethasone suppression test 24-hr urinary vanillylmandelic acid metanephrines and catecholamines 6 cm Solid versus cystic Clear vs. bloody Ross and Aron 1990 53 24-hr urinary vanillylmandelic acid metanephrines and catecholamines 6 cm Young 2000 54 Overnight 1 mg dexamethasone suppression test 24-hr urinary vanillylmandelic acid metanephrines and catecholamines 4 cm For suspected metastases or infection NIH 2002 3 Overnight 1 mg dexamethasone suppression test Plasma-free metanephrines 4 6 cm For suspected metastases treatment. An adrenal metastasis is relevant in the first sense but may be considered less relevant or even irrelevant in the second sense because of the impossibility to influence the bad prognosis. For such judgmental differences there are no universal right or wrong answers. The rise of evidence-based medicine is fostering transparency and accountability about the information we use in clinical practice. It is equally valuable to reveal how choices are guided by value judgments concerning process and outcome 38 . The combination of best evidence and careful patient-centered value judgment is the key to good clinical practice for adrenal inciden-taloma. 11 SURGERY FOR ADRENAL INCIDENTALOMA Surgery offers the most direct solution to the diagnostic-therapeutic dilemma of an adrenal incidentaloma tak- 6 cm Hormone Screening Active I nac t i v CT-scan Adrenal Incidentaloma ------------ữ Diameter Ộ Imaging at 2-6-18 months Figure 6 Strategic approach using a size criterion as the initial branch point. Translated into a simplified flowchart from the 1986 paper by Copeland 26 . Imaging