高达 5-7% 的成年人存在肾上腺肿块。 2016 年欧洲肾上腺偶发瘤管理指南对这些患者的检查进行了标准化，但缺乏其对临床实践影响的证据。对大量肾上腺肿块患者的临床表现、放射学特征和最终诊断进行回顾性审查1998 年至 2022 年转诊至三级护理中心。子分析比较了实施 2016 年指南之前和之后的结果。纳入了 1397 名患者（55.7% 为女性；中位年龄 60 岁[四分位数范围，IQR，49-70]）。偶然发现是最常见的表现方式 (63.7%)，30.6% 的患者肿块≥4 cm（中位 2.9 cm [IQR，1.9-4.7]）。 763 名患者可使用非增强计算机断层扫描 (CT) 亨斯菲尔德单位 (HU)；其中，32.9% 具有异质肿块或 >20 HU。最常见的诊断是肾上腺皮质腺瘤（ACA，56.0%）、嗜铬细胞瘤（12.7%）、肾上腺皮质癌（10.6%）和转移瘤（5.7%）。在多变量分析中，恶性肿瘤的显着预测因素包括 HU >20 或异质密度（比值比，OR 28.40）、雄激素过多（OR 27.67）、癌症监测期间检测到（OR 11.34）、尺寸≥4 cm（OR 6.11）和男性（或 3.06）。实施 2016 年指南后，良性非肾上腺切除术的数量减少（2016 年前为 6.1%，2016 年后为 4.5%），出院患者数量增加（2016 年前为 4.4%，2016 年后为 25.3%）。实施 2016 年指南对临床实践产生了积极影响，减少了不必要的手术，提高了良性肾上腺肿块的出院率，从而保护了医疗资源并减轻了患者负担。© 作者 2024。由牛津大学出版社代表欧洲内分泌学会。

Adrenal masses are found in up to 5-7% of adults. The 2016 European guidelines on the management of adrenal incidentalomas have standardised the workup of these patients, but evidence of their impact on clinical practice is lacking.Retrospective review of clinical presentation, radiological characteristics, and final diagnosis of a large cohort of patients with adrenal masses referred to a tertiary care centre 1998 to 2022. Sub-analysis compares outcomes before and after implementing the 2016 guidelines.1397 patients (55.7% women; median age 60 years [interquartile range, IQR, 49-70]) were included. Incidental discovery was the most frequent mode of presentation (63.7%) and 30.6% of patients had masses ≥4 cm (median 2.9 cm [IQR, 1.9-4.7]). Unenhanced computed tomography (CT) Hounsfield Units (HU) were available for 763 patients; of these, 32.9% had heterogeneous masses or >20 HU. The most common diagnoses were adrenocortical adenoma (ACA, 56.0%), phaeochromocytoma (12.7%), adrenocortical carcinoma (10.6%), and metastases (5.7%). At multivariable analysis, significant predictors of malignancy included HU >20 or heterogeneous density (Odds Ratio, OR 28.40), androgen excess (OR 27.67), detection during cancer surveillance (OR 11.34), size ≥4 cm (OR 6.11) and male sex (OR 3.06). After implementing the 2016 guidelines, the number of adrenalectomies decreased (6.1% pre-2016 vs. 4.5% post-2016) and the number of patients discharged increased (4.4% pre-2016 vs. 25.3% post-2016) for benign non-functioning adrenal masses.Implementing the 2016 guidelines positively impacted clinical practice, reducing unnecessary surgeries and increasing the discharge rate for benign adrenal masses, thereby preserving healthcare resources and patient burden.© The Author(s) 2024. Published by Oxford University Press on behalf of European Society of Endocrinology.