841 KB43 KB192920262024Kocjan, TomažRoš, ZalaRoš, Zalaštevilka:5/6letnik:93str. 198-206DOI:10.6016/ZdravVestn.3504ISSN:1318-0347COBISSID:203376643URN:URN:NBN:SI:doc-LE91DGJSslSlovensko zdravniško društvoZdravniški vestnikincidentalomkarcinommitotannadledvičnicaračunalniška tomografijaIncidentalom nadledvičnice – prava narava, razkrita zaradi težjega poteka covida-19| Adrenal incidentaloma – the true nature unmasked by severe Covid-19|An adrenal incidentaloma is an asymptomatic lesion incidentally detected on imaging for reasons other than adrenal disease. Their prevalence is rising sharply due to the increasing number of imaging studies performed. These are predominantly benign, hormonally inactive adenomas. When an incidentaloma is detected, it is necessary to differentiate between benign and malignant lesions and to identify any hormonal activity. We present the modern management of incidentalomas by means of an exceptional clinical case of a female patient with a tiny incidentaloma of the left adrenal gland. Despite a high density on native computed tomography (CT), the lesion was considered benign based on contrast washout, and further morphological follow-up was deemed unnecessary in accordance with the practice at the time. Nevertheless, the patient underwent several imaging examinations in the following years, due to various health problems, but there was no change in tumour size. Only six years after the discovery, a chest CT was advised due to the consequences of COVID-19, which revealed a marked tumour growth. The patient was referred for left-sided laparoscopic adrenalectomy. Adrenocortical carcinoma was confirmed pathohistologically and adjuvant adrenolytic therapy with mitotane was instituted. Adrenal incidentalomas are predominantly benign and clinically insignificant but can sometimes be life-threatening, so it is important to manage them according to the guidelines presented. In exceptional cases with an atypical course, as in our patient, management by an interdisciplinary team will be crucial for a favourable outcomeIncidentalom nadledvičnice je sprememba brez simptomov, naključno odkrita pri slikovnih preiskavah zaradi razlogov, ki ne vključujejo bolezni nadledvičnic. Njihova prevalenca strmo narašča na račun vedno večjega števila opravljenih slikovnih preiskav. Pretežno gre za benigne, hormonsko neaktivne adenome. Ob odkritju incidentaloma moramo razlikovati med benignimi in malignimi spremembami ter ugotoviti morebitno hormonsko aktivnost. Sodobno obravnavo incidentalomov predstavljava na izjemnem kliničnem primeru bolnice z drobnim incidentalomom leve nadledvičnice. Kljub visoki gostoti na nativni računalniški tomografiji (CT) smo na podlagi izplavljanja kontrasta v skladu s takratno prakso spremembo označili za benigno in odsvetovali nadaljnje morfološko spremljanje. Kljub temu je bolnica v naslednjih letih zaradi različnih zdravstvenih težav opravila več slikovnih preiskav, vendar spremembe velikosti tumorja ni bilo. Šele 6 let od odkritja so zaradi posledic covida-19 svetovali CT prsnega koša, ki je razkril izrazito rast tumorja. Bolnico smo napotili na levostransko laparoskopsko adrenalektomijo. Patohistološko je bil potrjen karcinom skorje nadledvične žleze, zato smo uvedli adjuvantno adrenolitično zdravljenje z mitotanom. Incidentalomi nadledvičnic so pretežno benigni in klinično nepomembni, včasih pa lahko ogrozijo življenje. Zato je pomembno, da jih obravnavamo v skladu s predstavljenimi smernicami. V izjemnih primerih z atipičnim potekom, kot je bilo pri naši bolnici, bo za ugoden razplet ključna obravnava znotraj interdisciplinarnega timaTEXTznanstveno časopisjejournalsSlovenian National E-content AggregatorNational and University Library of SloveniaSlovensko zdravniško društvo