Clinical analysis of adrenal incidentaloma in children / 中华实用儿科临床杂志

ABSTRACT

Objective:To explore the clinical characteristics and treatment regimens of adrenal incidentaloma (AI) in children.Methods:Clinical data of 38 children with AI treated in the Department of Urology, Children′s Hospital of Nanjing Medical University from December 2016 to October 2021 were retrospectively analyzed.A total of 38 children were divided into neonatal group and non-neonatal group according to their age at first diagnosis.The neonatal group had 7 males and 9 females patients, of whom 7 cases were detected with AI during prenatal examinations, 9 cases were diagnosed postnatally.Four children in neonatal group had AI in the left adrenal gland and 12 cases in the right, with the maximum diameter of tumor (MDT) ranging from 16-48 mm.In the non-neonatal group, there were 14 males and 8 females patients aged 7 months and 1 day to 12 years and 1 month, and the MDT was 29-131 mm.Paired t test was used to compare the age and MDT of benign and malignant tumors. Results:In the neonatal group, 3 patients were surgically treated, with 2 cases and 1 case of neuroblastoma and teratoma confirmed by postoperative histology, respectively.The remaining 13 patients in the neonatal group were followed up for 1-31 months, with 8 cases and 5 cases of complete remission and significantly decreased tumor volume, respectively.In the non-neonatal group, there were 3, 9 and 10 patients received open biopsy, laparoscopic adrenalectomy, and open adrenalectomy, respectively.Of these 22 surgically treated cases, 8 cases had a benign lesion, including ganglioneuroma ( n=4), adrenocortical adenoma ( n=1), adrenal cyst ( n=1), teratoma ( n=1), and pheochromocytoma ( n=1); while 14 cases had a malignant lesion, including neuroblastoma ( n=8), ganglioneuroblastoma ( n=5), and adrenocortical carcinoma ( n=1). The mean age of patients with malignant tumors was significantly younger than those with benign tumors[(38.94±35.44) months vs.(95.89±41.43) months, t=3.63, P=0.001]. The mean MDT in malignant tumors was significantly longer than that of benign tumors[(64.43±25.20) mm vs.(41.44±15.66) mm, t=2.45, P=0.023]. Conclusions:AI in children has a high risk of malignancy.Therefore, more detailed examinations are needed to detect tumor markers and endocrinological parameters, and imaging tests such as non-contrast and CT examination should be performed as early as possible.AI in children is predominantly neuroblastic tumors.For non-neonatal patients, surgery should be performed as early as possible.For AI found in the neonatal period and prenatal examination, expectant management is feasible if the tumor is relatively small and limited to the adrenal gland without distant metastases.