日期：2015-08-27

地點：中華廳

時間：08:40-09:30

個人簡介

Dr. Young isProfessor of Medicine inTheMayo Clinic College of Medicine. As Chair of theDivision of Endocrinology at Mayo Clinic he leads one of the largest endocrinedepartments in the world. He is is a Past President of the Endocrine Societyand is the current Chair of the American Board of Internal MedicineSubspecialty Board in Endocrinology. Dr.Young has published over 240 articles on endocrine hypertension andAdrenalandpituitary disorders. He has been the recipient of multiple education awards andhas presented at over 350 national and international meetings and he has beenan invited visiting professor for more than 100 medical institutions.

題目：

William F. Young, Jr., MD, MSc, Professorof Medicine, Mayo Clinic Collegeof Medicine

Mayo Clinic, Rochester, MN,USA

Anadrenal incidentaloma is defined as aMasslesion >1-cm in diameter serendipitouslyDiscoveredby radiologic examination, in the absence of symptoms or clinicalfindings suggestive of adrenal disease (Young, 2007). This "new" clinical entity is theresult of technological advances in the field of computerized imaging such astransmission computed body tomography (CT) and magnetic resonance imaging(MRI). The diagnosis of an incidental adrenal mass is frequent because 2 to 15%of individuals have adrenal cortical tumors at autopsy. The adrenalincidentaloma must be characterized with respect to: a) functional statuswith history and physical examination andhormonal assessment; and b) malignantpotentialwith “imaging phenotype” and size

Functional Status:

The optimal diagnostic approach for adrenal incidentalomas is indebate. However, most clinicians wouldagree that the evaluation of the patient with an adrenal incidentaloma shouldstart with a history and physical examination focusing on signs and symptoms ofadrenal hyperfunction and malignancy. Sufficient evidence exists to supportcase-detection testing for the following forms of adrenal hyperfunction orautonomous function: subclinical Cushingsyndrome (or subclinical glucocorticoid secretory autonomy); pheochromocytoma;and, primary aldosteronism in patients with hypertension.

MalignantPotential:

Imaging phenotype does not predicthormonal function, however, it does predict underlying pathology, and surgicalresection of the adrenal mass should be considered in patients with adrenalincidentalomas that have a suspicious imaging phenotype.

Follow-up:

Oneof the most controversial issues in the management of a patient with adrenalincidentaloma is the frequency and duration of follow-up evaluations. Allpatients should have at least one follow-up imaging study. In addition, repeattesting (eg, annually for 4 years) for subclinical Cushing syndrome should beconsidered.

*Young WF Jr: TheIncidentallydiscovered adrenalmass. N Engl J Med 356:51-60, 2007.

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