Lutsenko L. Adrenal glands insidentalomas^ clinical and diagnostic aspekts

Object of the study: adrenal glands incidentalomas (AI). Aim of the study: to improve the algorithm of management tactics of patients’ with AI by developing clear differential criteria for malignancy of the process based on the research of ultrasonic and tomographic characteristics of tumor data. Methods of the study and equipment: clinical, biochemical, hormonal, histological, instrumental, statistic; ultrasound machine «Toshiba» SSA-240A, tomography apparatus CT-9000HP, Brightspeed. Theoretical and practical results: based on long-term observation of patients a complex analysis of hormone, ultrasound and tomographic methods of diagnosis of tumors of the adrenal glands was conducted and tomographic criteria and their parameters for detection of incidentalomas malignancy were systematized. The algorithm of management tactics of patients with AI was given taking into consideration hormonal hypersecretions and using tomographic signs. Indications for the dynamic observation and surgical treatment of patients with AI were developed. The criteria for the diagnosis of AI that are less than 4-6 cm were determined. Novelty: expedience and efficiency of the analysis of tomographic signs in differential diagnosis of AI were given. It was determined that tomographic signs - contrasting density and density gradient - alone or in combination indicate a high malignant potential of AI, confirming its proliferative and metabolic activity. It was proved that anamnestic oncological record does not confirm metastatic nature of AI. The possibility of false-positive raising of the level of the daily renal excretion of metanephrines that is common among the patients with hormonally inactive adrenocortical adenomas was found. The degree of introduction: implemented in practice the algorithm of the management of the patients with AI in the State Institution «V.P. Komissarenko Institute of Endocrinology and Metabolism of NAMS of Ukraine», National Cancer Institute, City Clinical Endocrinology Center of Kyiv. Sphere of application: endocrinology.