Kazan medical journalKazan medical journalКазанский медицинский журнал0368-48142587-9359Eco-Vector1153910.17816/KMJ2019-277ReviewsОбзорыReview ArticleAdrenal incidentaloma: management of patients with functionally autonomous cortisol synthesisИнциденталома надпочечников: ведение пациентов с функционально автономным синтезом кортизолаChzhenT RЧженТатьяна Романовнаdoctortr@mail.ruKiselevaT PКиселёваТатьяна Петровнаdoctortr@mail.ruTorosyanM RТоросянМаргарита Рафаеловнаdoctortr@mail.ruUral State Medical UniversityУральский государственный медицинский университет290320191002VOL 100, NO2 (2019)ТОМ 100, №2 (2019)27728729032019Copyright ©; 2019, Chzhen T.R., Kiseleva T.P., Torosyan M.R.Copyright ©; 2019, Чжен Т.Р., Киселёва Т.П., Торосян М.Р.2019Chzhen T.R., Kiseleva T.P., Torosyan M.R.Чжен Т.Р., Киселёва Т.П., Торосян М.Р.http://creativecommons.org/licenses/by-nc-sa/4.0https://kazanmedjournal.ru/kazanmedj/article/view/11539

Over recent decades due to improved visualization (ultrasound, computer tomography and magnetic resonance imaging) prevalence of adrenal incidentaloma has increased. The term «adrenal incidentaloma» is generic and includes a group of tumors of various morphology and over 1 cm in diameter accidentally discovered during radiologic investigation. The found tumor can be hormonally inactive or actively releasing different hormones, malignant or benign, and originating from different adrenal zones or having non-specific organ origin. Based on the frequency of revealing and clinical significance the most noteworthy is functionally autonomous cortisol synthesis. It means changes of hypothalamic pituitary adrenal axis without classic clinically prominent signs of cortisol excess such as proximal myopathy, stretch marks, body fat redistribution and other metabolic changes related to cortisol. Currently a large number of recommendations on the management and tactics of treatment of adrenal incidentaloma can be found in the literature. Based on the analysis of these guidelines the conclusions were made about the diagnostic errors and incorrect approaches to the choice of treatment of such patients. Recently a lot of studies have been directed to the early detection of carbohydrate and lipid metabolism disorders, relation with obesity and type 2 diabetes mellitus, arterial hypertension and osteoporosis for preserved quality of life of such patients. Influence of hypercorticism is considered to worsen the course of these conditions but at the moment no effect of adrenalectomy on mortality and life duration was confirmed.

В последние десятилетия в связи с усовершенствованием методов визуализации (ультразвуковое исследование, компьютерная и магнитно-резонансная томография) увеличилась распространённость инциденталом надпочечника. Термин «инциденталома надпочечника» является собирательным, включающим разнообразную по морфологии группу опухолей более 1 см в диаметре, случайно выявленных при радиологическом исследовании. Обнаруженное образование может оказаться как гормонально неактивным, так и активно синтезирующим различные гормоны, как злокачественным, так и доброкачественным, а также исходить из различных зон надпочечника или иметь неспецифичную органную принадлежность. По частоте выявления и клинической значимости наибольшего внимания клиницистов заслуживает функционально автономный синтез кортизола. Он подразумевает изменения оси гипоталамус-гипофиз-надпочечники без классических клинически явных признаков избытка кортизола, таких как проксимальная миопатия, полосы растяжения, перераспределение жировой ткани и другие метаболические изменения, связанные с кортизолом. В настоящее время в литературе существует большое количество рекомендаций по ведению и тактике лечения инциденталом надпочечника. На основании анализа этих рекомендаций были сделаны выводы в отношении диагностических ошибок и неправильных подходов к выбору лечения таких пациентов. В последнее время много исследований направлено на раннее выявление нарушений углеводного и липидного обмена, связи с ожирением и сахарным диабетом 2-го типа, артериальной гипертензии и остеопороза для сохранения качества жизни таких пациентов. Считают, что влияние гиперкортицизма усугубляет течение этих состояний, однако на данный момент не доказано влияние адреналэктомии на смертность и продолжительность жизни этих пациентов.

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