{"id":19442,"date":"2025-12-18T21:47:45","date_gmt":"2025-12-18T21:47:45","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/es\/?p=19442"},"modified":"2025-12-19T15:26:18","modified_gmt":"2025-12-19T15:26:18","slug":"tumores-suprarrenales-diagnostico-conducta-y-el-papel-de-la-puncion-ecoguiada","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/es\/temas-generales\/tumores-suprarrenales-diagnostico-conducta-y-el-papel-de-la-puncion-ecoguiada\/","title":{"rendered":"Tumores Suprarrenales: Diagn\u00f3stico, Conducta y el Papel de la Punci\u00f3n Ecoguiada"},"content":{"rendered":"\n<p><br>Durante el examen de ecoendoscopia, fue identificada la imagen en la adrenal isquierda:<\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><a href=\"https:\/\/endoscopiaterapeutica.net\/es\/tumor-adrenal\/\"><img fetchpriority=\"high\" decoding=\"async\" width=\"644\" height=\"394\" src=\"https:\/\/endoscopiaterapeutica.net\/es\/wp-content\/uploads\/2025\/12\/tumor-adrenal.jpg\" alt=\"\" class=\"wp-image-19441\" srcset=\"https:\/\/endoscopiaterapeutica.net\/es\/wp-content\/uploads\/2025\/12\/tumor-adrenal.jpg?v=1765868632 644w, https:\/\/endoscopiaterapeutica.net\/es\/wp-content\/uploads\/2025\/12\/tumor-adrenal-300x184.jpg?v=1765868632 300w, https:\/\/endoscopiaterapeutica.net\/es\/wp-content\/uploads\/2025\/12\/tumor-adrenal-585x358.jpg?v=1765868632 585w\" sizes=\"(max-width: 644px) 100vw, 644px\" \/><\/a><\/figure>\n<\/div>\n\n\n<p>Ante este hallazgo incidental, \u00bfcu\u00e1l ser\u00eda su conducta?<\/p>\n\n\n\n<ol style=\"list-style-type:lower-alpha\" class=\"wp-block-list\">\n<li>Punci\u00f3n ecoguiada con FNA<\/li>\n\n\n\n<li>Punci\u00f3n ecoguiada con FNB<\/li>\n\n\n\n<li>Discusi\u00f3n multidisciplinar<\/li>\n<\/ol>\n\n\n\n<p>Los tumores suprarrenales \u2014 tambi\u00e9n llamados incidentalomas suprarrenales \u2014 son hallazgos cada vez m\u00e1s frecuentes en estudios de imagen realizados por otras razones. Este art\u00edculo revisa las principales recomendaciones para la evaluaci\u00f3n, el diagn\u00f3stico diferencial y el tratamiento de estas lesiones, destacando el papel de la ecoendoscopia en la caracterizaci\u00f3n de las masas suprarrenales.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><br><strong>\u00bfQu\u00e9 es un incidentaloma suprarrenal?<\/strong><\/h2>\n\n\n\n<p>Un incidentaloma suprarrenal es una masa \u22651 cm detectada incidentalmente en estudios de imagen sin sospecha cl\u00ednica de enfermedad suprarrenal. Su prevalencia estimada es de alrededor del 2% en la poblaci\u00f3n general y puede superar el 10% en personas mayores de 80 a\u00f1os.<\/p>\n\n\n\n<p>La gl\u00e1ndula suprarrenal tambi\u00e9n es un sitio com\u00fan de met\u00e1stasis, especialmente de tumores de pulm\u00f3n, mama, ri\u00f1\u00f3n, melanoma y del tracto gastrointestinal, siendo el cuarto sitio m\u00e1s frecuente de diseminaci\u00f3n metast\u00e1sica. En pacientes con c\u00e1ncer extrasuprarrenal, hasta el 75% de las masas suprarrenales representan met\u00e1stasis.<\/p>\n\n\n\n<p>La distinci\u00f3n entre lesiones benignas y malignas es esencial, ya que define el curso de acci\u00f3n: seguimiento, cirug\u00eda o quimioterapia.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><br><strong>Avaliaci\u00f3n inicial y cribado hormonal<\/strong><\/h2>\n\n\n\n<p>Incluso los tumores funcionales pueden ser cl\u00ednicamente asintom\u00e1ticos. Por lo tanto, todo incidentaloma debe evaluarse bioqu\u00edmicamente para descartar:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Feocromocitoma:<\/strong> medir metanefrinas plasm\u00e1ticas o urinarias;<\/li>\n\n\n\n<li><strong>Hiperproducci\u00f3n de cortisol:<\/strong> prueba de supresi\u00f3n con dexametasona (1 mg);<\/li>\n\n\n\n<li><strong>Hiperaldosteronismo prim\u00e1rio:<\/strong> en pacientes hipertensos.<\/li>\n<\/ul>\n\n\n\n<p>La excluci\u00f3n de feocromocitoma es <strong>recomendada antes de cualquier bi\u00f3psia de la suprarrenal<\/strong>, para prevenir la precipitaci\u00f3n de una posible crise hipertensiva.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><br><strong>Diagn\u00f3stico por imagen<\/strong><\/h2>\n\n\n\n<p>La <strong>tomografia computadorizada (TC) sin contraste<\/strong> es el examen de primeira linea.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Lesiones benignas:<\/strong> homogeneas, &lt; 4 cm y con atenuaciones \u2264 10 unidades Hounsfield (UH), s\u00e3o consideradas adenomas e n\u00e3o necessitam de acompanhamento adicional.<\/li>\n\n\n\n<li><strong>Lesiones suspeitas:<\/strong> tama\u00f1o &gt; 4 cm, heterogeneas, UH &gt; 10, m\u00e1rgenes irregulares o \u00e1reas de necrosis y calcificaci\u00f3n indican mayor riesgo de carcinoma adrenocortical (CAC).<\/li>\n<\/ul>\n\n\n\n<p>El riesgo de CAC es &lt; 2% en lesiones &lt; 4 cm, 6% entre 4\u20136 cm y \u2265 25% en masas \u2265 6 cm.<\/p>\n\n\n\n<p>Cuando las TC no son concluyentes, se puede utilizar la resonancia magn\u00e9tica (RM) o la tomograf\u00eda por emisi\u00f3n de positrones (PET) con 18F-fluoro-2-desoxi-D-glucosa (FDG) para una caracterizaci\u00f3n m\u00e1s detallada.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><br><strong>Punci\u00f3n ecoguiada de la suprarrenal<\/strong><\/h2>\n\n\n\n<p>La <strong>biopsia suprarrenal rara vez es necesaria<\/strong>, pero puede ser crucial en casos con antecedentes de neoplasia maligna extrasuprarrenal (sospecha de met\u00e1stasis) o cuando el diagn\u00f3stico influye directamente en el tratamiento.<\/p>\n\n\n\n<p>La <strong>biopsia por aspiraci\u00f3n con aguja fina guiada por ecograf\u00eda (EUS-FNA\/FNB<\/strong>) est\u00e1 ganando popularidad por su seguridad y precisi\u00f3n.<\/p>\n\n\n\n<p><strong>Ventajas de la EUS-FNA\/FNB:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Seguridad:<\/strong> tasas de complicaciones cercanas al 0%, en comparaci\u00f3n con hasta un 4% con el abordaje percut\u00e1neo.<\/li>\n\n\n\n<li><strong>Alta precisi\u00f3n:<\/strong> sensibilidad del 86% al 100% y especificidad del 97% al 100% para met\u00e1stasis.<\/li>\n\n\n\n<li><strong>Acceso anat\u00f3mico favorable:<\/strong> la gl\u00e1ndula suprarrenal izquierda es f\u00e1cilmente accesible a trav\u00e9s de la pared g\u00e1strica posterior, sin estructuras cr\u00edticas interpuestas.<\/li>\n\n\n\n<li><strong>Impacto cl\u00ednico:<\/strong> la confirmaci\u00f3n de met\u00e1stasis puede evitar cirug\u00edas innecesarias y guiar el tratamiento sist\u00e9mico.<\/li>\n<\/ul>\n\n\n\n<p><strong>La bi\u00f3psia es recomendada si se cumplen tres criterios:<\/strong><\/p>\n\n\n\n<p>1. La lesi\u00f3n presenta inactividad hormonal (feocromocitoma excluido);<\/p>\n\n\n\n<p>2. Las im\u00e1genes no caracterizan de forma concluyente una lesi\u00f3n benigna;<\/p>\n\n\n\n<p>3. El resultado histol\u00f3gico puede modificar el tratamiento cl\u00ednico.<\/p>\n\n\n\n<p>En pacientes oncol\u00f3gicos, el estudio es \u00fatil para <strong>confirmar met\u00e1stasis aisladas<\/strong>, evaluar la respuesta terap\u00e9utica o redefinir el estadificaci\u00f3n.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><br><strong>Conducta e tratamento<\/strong><\/h2>\n\n\n\n<p>El tratamiento debe <strong>individualizarse<\/strong> seg\u00fan el tipo de lesi\u00f3n y el perfil hormonal.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Lesiones benignas y no funcionantes (&lt; 4 cm, \u2264 10 UH):<\/strong> generalmente no requieren intervenci\u00f3n ni seguimiento prolongado.<\/li>\n\n\n\n<li><strong>Lesiones sospechosas o malignas:<\/strong> se indica adrenalectom\u00eda laparosc\u00f3pica. La decisi\u00f3n quir\u00fargica debe considerar el tama\u00f1o, el crecimiento, las caracter\u00edsticas radiol\u00f3gicas y el estado funcional.<\/li>\n\n\n\n<li><strong>Met\u00e1stasis suprarrenales confirmadas:<\/strong> pueden tratarse con quimioterapia sist\u00e9mica o cirug\u00eda de resecci\u00f3n en casos seleccionados.<\/li>\n<\/ul>\n\n\n\n<p>El manejo ideal es <strong>multidisciplinar<\/strong>, con la participaci\u00f3n de un endocrin\u00f3logo, un radi\u00f3logo, un cirujano y un endoscopista intervencionista.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><br><strong>Puntos clave<\/strong><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Alta prevalencia:<\/strong> los incidentalomas suprarrenales aumentan con la edad y con frecuencia son benignos.<\/li>\n\n\n\n<li><strong>Diagn\u00f3stico inicial:<\/strong> la tomograf\u00eda computarizada sin contraste define la benignidad (\u226410 UH, &lt;4 cm).<\/li>\n\n\n\n<li><strong>Cribado hormonal:<\/strong> feocromocitoma, hipercortisolismo y, en pacientes hipertensos, hiperaldosteronismo.<\/li>\n\n\n\n<li><strong>Biopsia ecoguiada (EUS-FNA\/FNB):<\/strong> un m\u00e9todo seguro, m\u00ednimamente invasivo y de alta precisi\u00f3n para confirmar met\u00e1stasis.<\/li>\n\n\n\n<li><strong>Biopsia selectiva:<\/strong> indicada solo si el resultado altera el manejo cl\u00ednico.<\/li>\n\n\n\n<li><strong>Enfoque integrado:<\/strong> las decisiones terap\u00e9uticas deben discutirse en un equipo multidisciplinario.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><br><strong>Consideraciones finales<\/strong><\/h2>\n\n\n\n<p class=\"has-pale-ocean-gradient-background has-background\">Los tumores suprarrenales requieren una evaluaci\u00f3n cuidadosa para evitar cirug\u00edas innecesarias y retrasos en el diagn\u00f3stico de neoplasias malignas. La ecoendoscopia con PAAF\/BAAF puede ayudar en el diagn\u00f3stico diferencial de los tumores suprarrenales; sin embargo: 1.) solo debe indicarse tras una consulta multidisciplinaria y 2.) debe descartarse el feocromocitoma antes de la biopsia.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><br> <strong>Referencias<\/strong><\/h2>\n\n\n\n<ol class=\"wp-block-list\">\n<li>DeWitt J, Alsatie M, LeBlanc J, McHenry L, Sherman S. Endoscopic ultrasound-guided fine-needle aspiration of left adrenal gland masses. Endoscopy. 2007;39(1):65-71. doi:10.1055\/s-2006-945042<\/li>\n\n\n\n<li>Martin-Cardona A, Fernandez-Esparrach G, Subtil JC, et al. EUS-guided tissue acquisition in the study of the adrenal glands: Results of a nationwide multicenter study. PLoS One. 2019;14(6):e0216658. Published 2019 Jun 6. doi:10.1371\/journal.pone.0216658<\/li>\n\n\n\n<li>Sherlock M, Scarsbrook A, Abbas A, et al. Adrenal Incidentaloma. Endocr Rev. 2020;41(6):775-820. doi:10.1210\/endrev\/bnaa008<\/li>\n\n\n\n<li>Kebebew E. Adrenal Incidentaloma. N Engl J Med. 2021;384(16):1542-1551. doi:10.1056\/NEJMcp2031112<\/li>\n\n\n\n<li>Fassnacht M, Tsagarakis S, Terzolo M, et al. European Society of Endocrinology clinical practice guidelines on the management of adrenal incidentalomas, in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol. 2023;189(1):G1-G42. doi:10.1093\/ejendo\/lvad066<\/li>\n\n\n\n<li>Zhang CD, Erickson D, Levy MJ, et al. ENDOSCOPIC ULTRASOUND-GUIDED FINE-NEEDLE ASPIRATION IN THE DIAGNOSIS OF ADRENAL METASTASIS IN A HIGH-RISK POPULATION. Endocr Pract. 2017;23(12):1402-1407. doi:10.4158\/EP-2017-0022<\/li>\n\n\n\n<li>Carasel A, Calissendorff J, Juhlin CC, Falhammar H. Cytological Assessment of Adrenal Tumours: Insights From 22-Years Single Centre Experience. Clin Endocrinol (Oxf). 2025;103(2):157-166. doi:10.1111\/cen.15254<\/li>\n\n\n\n<li>Eloubeidi MA, Black KR, Tamhane A, Eltoum IA, Bryant A, Cerfolio RJ. A large single-center experience of EUS-guided FNA of the left and right adrenal glands: diagnostic utility and impact on patient management. Gastrointest Endosc. 2010;71(4):745-753. doi:10.1016\/j.gie.2009.10.022<\/li>\n\n\n\n<li>Martinez M, LeBlanc J, Al-Haddad M, Sherman S, DeWitt J. Role of endoscopic ultrasound fine-needle aspiration evaluating adrenal gland enlargement or mass. World J Nephrol. 2014;3(3):92-100. doi:10.5527\/wjn.v3.i3.92<\/li>\n\n\n\n<li>Novotny AG, Reynolds JP, Shah AA, et al. Fine-needle aspiration of adrenal lesions: A 20-year single institution experience with comparison of percutaneous and endoscopic ultrasound guided approaches. Diagn Cytopathol. 2019;47(10):986-992. doi:10.1002\/dc.24261<\/li>\n<\/ol>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>C\u00f3mo citar este art\u00edculo<\/strong><\/h2>\n\n\n\n<p class=\"has-very-light-gray-to-cyan-bluish-gray-gradient-background has-background\">Mendieta PJO, Penaloza CSQ. Tumores Suprarrenales: Diagn\u00f3stico, Conducta y el Papel de la Punci\u00f3n Ecoguiada. Endoscopia Terap\u00e9utica 2025, Vol II. Disponible en: <a href=\"https:\/\/endoscopiaterapeutica.net\/es\/?p=19442\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/endoscopiaterapeutica.net\/es\/sin-categoria\/tumores-suprarrenales-diagnostico-conducta-y-el-papel-de-la-puncion-ecoguiada\/<\/a><\/p>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Durante el examen de ecoendoscopia, fue identificada la imagen en la adrenal isquierda: Ante&hellip;<\/p>\n","protected":false},"author":6150,"featured_media":19441,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[151],"tags":[],"ano":[750],"tipo":[154],"volume":[147],"class_list":["post-19442","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-temas-generales","ano-750","tipo-ultrasonido-endoscopico","volume-volumen-ii"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.2 (Yoast SEO v27.3) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Tumores Suprarrenales: Diagn\u00f3stico, Conducta y el Papel de la Punci\u00f3n Ecoguiada &#8226; Endoscopia Terapeutica<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/endoscopiaterapeutica.net\/es\/temas-generales\/tumores-suprarrenales-diagnostico-conducta-y-el-papel-de-la-puncion-ecoguiada\/\" \/>\n<meta property=\"og:locale\" content=\"es_ES\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Tumores Suprarrenales: Diagn\u00f3stico, Conducta y el Papel de la Punci\u00f3n Ecoguiada\" \/>\n<meta property=\"og:description\" content=\"Durante el examen de ecoendoscopia, fue identificada la imagen en la adrenal isquierda: Ante este hallazgo incidental, \u00bfcu\u00e1l ser\u00eda su conducta? 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