{"id":20899,"date":"2025-12-16T07:00:00","date_gmt":"2025-12-16T07:00:00","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/?p=20899"},"modified":"2025-12-12T12:32:16","modified_gmt":"2025-12-12T12:32:16","slug":"tumores-adrenais-diagnostico-conduta-e-o-papel-da-puncao-ecoguiada","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/tumores-adrenais-diagnostico-conduta-e-o-papel-da-puncao-ecoguiada\/","title":{"rendered":"Tumores Adrenais: Diagn\u00f3stico, Conduta e o Papel da Pun\u00e7\u00e3o Ecoguiada"},"content":{"rendered":"\n<p><br>Durante exame de ecoendoscopia, a imagem a seguir foi identificada na adrenal esquerda:<\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/?attachment_id=20908\"><img fetchpriority=\"high\" decoding=\"async\" width=\"644\" height=\"394\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2025\/12\/tumor-adrenal.jpg\" alt=\"\" class=\"wp-image-20908\" srcset=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2025\/12\/tumor-adrenal.jpg?v=1764788443 644w, https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2025\/12\/tumor-adrenal-300x184.jpg?v=1764788443 300w, https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2025\/12\/tumor-adrenal-585x358.jpg?v=1764788443 585w\" sizes=\"(max-width: 644px) 100vw, 644px\" \/><\/a><\/figure>\n<\/div>\n\n\n<p>Diante deste achado incidental, qual seria a sua conduta?<\/p>\n\n\n\n<ol style=\"list-style-type:lower-alpha\" class=\"wp-block-list\">\n<li>Discuss\u00e3o multidisciplinar<\/li>\n\n\n\n<li>Pun\u00e7\u00e3o ecoguiada com FNA<\/li>\n\n\n\n<li>Pun\u00e7\u00e3o ecoguiada com FNB<\/li>\n<\/ol>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Afinal o que \u00e9 um incidentaloma adrenal?<\/strong><\/h2>\n\n\n\n<p>Os tumores adrenais \u2014 tamb\u00e9m chamados de <em>incidentalomas adrenais<\/em> quando encontrados incidentalmente \u2014 s\u00e3o achados cada vez mais frequentes nos exames de imagem realizados por outros motivos. <\/p>\n\n\n\n<p>Um <em>incidentaloma adrenal<\/em> \u00e9 uma massa \u22651 cm detectada incidentalmente em exames de imagem sem suspeita cl\u00ednica de doen\u00e7a adrenal. A preval\u00eancia estimada \u00e9 de cerca de 2% na popula\u00e7\u00e3o geral, podendo ultrapassar 10% acima dos 80 anos.<\/p>\n\n\n\n<p>A gl\u00e2ndula adrenal tamb\u00e9m \u00e9 um s\u00edtio comum de met\u00e1stases \u2014 especialmente de tumores de pulm\u00e3o, mama, rim, melanoma e trato gastrointestinal \u2014 sendo o quarto local mais frequente de dissemina\u00e7\u00e3o metast\u00e1tica. <strong>Em pacientes com c\u00e2ncer extra-adrenal, at\u00e9 75% das massas adrenais representam met\u00e1stases.<\/strong><\/p>\n\n\n\n<p>A distin\u00e7\u00e3o entre les\u00f5es benignas e malignas \u00e9 essencial, pois define a conduta: acompanhamento, cirurgia ou quimioterapia.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><br><strong>Avalia\u00e7\u00e3o inicial e triagem hormonal<\/strong><\/h2>\n\n\n\n<p>Mesmo tumores funcionais podem ser clinicamente silenciosos. Assim, todo incidentaloma deve ser avaliado bioquimicamente para descartar:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Feocromocitoma:<\/strong> dosagem de metanefrinas plasm\u00e1ticas ou urin\u00e1rias;<\/li>\n\n\n\n<li><strong>Hiperprodu\u00e7\u00e3o de cortisol:<\/strong> teste de supress\u00e3o com dexametasona (1 mg);<\/li>\n\n\n\n<li><strong>Hiperaldosteronismo prim\u00e1rio:<\/strong> em pacientes hipertensos.<\/li>\n<\/ul>\n\n\n\n<p>A exclus\u00e3o de feocromocitoma \u00e9 <strong>recomendada antes de qualquer bi\u00f3psia da adrenal<\/strong>, para prevenir a precipita\u00e7\u00e3o de uma poss\u00edvel crise hipertensiva.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><br><strong>Diagn\u00f3stico por imagem<\/strong><\/h2>\n\n\n\n<p>A <strong>tomografia computadorizada (TC) sem contraste<\/strong> \u00e9 o exame de primeira linha.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Les\u00f5es benignas:<\/strong> homog\u00eaneas, &lt;4 cm e com atenua\u00e7\u00e3o \u226410 unidades Hounsfield (UH), s\u00e3o consideradas adenomas e n\u00e3o necessitam de acompanhamento adicional.<\/li>\n\n\n\n<li><strong>Les\u00f5es suspeitas:<\/strong> tamanho &gt;4 cm, heterogeneidade, UH &gt;10, margens irregulares ou \u00e1reas de necrose e calcifica\u00e7\u00e3o indicam maior risco de carcinoma adrenocortical (CAC).<\/li>\n<\/ul>\n\n\n\n<p>O risco de CAC \u00e9 &lt;2% em les\u00f5es &lt;4 cm, 6% entre 4\u20136 cm e \u226525% em massas \u22656 cm.<\/p>\n\n\n\n<p>Quando a TC \u00e9 inconclusiva, podem ser utilizados resson\u00e2ncia magn\u00e9tica (RM) ou tomografia por emiss\u00e3o de positr\u00f5es (PET) com 18F-fluor-2-desoxi-D-glicose (FDG) para caracteriza\u00e7\u00e3o adicional.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><br><strong>Pun\u00e7\u00e3o ecoguiada da adrenal<\/strong><\/h2>\n\n\n\n<p>A <strong>bi\u00f3psia da adrenal<\/strong> raramente \u00e9 necess\u00e1ria, mas pode ser decisiva em casos com hist\u00f3rico de malignidade extra-adrenal ou quando o diagn\u00f3stico influencia diretamente o tratamento.<\/p>\n\n\n\n<p>A <strong>pun\u00e7\u00e3o aspirativa\/bi\u00f3psia ecoguiada (EUS-FNA\/FNB)<\/strong>, vem ganhando destaque pela seguran\u00e7a e precis\u00e3o.<\/p>\n\n\n\n<p><strong>Vantagens da EUS-FNA\/FNB:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Seguran\u00e7a:<\/strong> taxas de complica\u00e7\u00f5es pr\u00f3ximas a 0%, comparadas a at\u00e9 4% na via percut\u00e2nea.<\/li>\n\n\n\n<li><strong>Alta acur\u00e1cia:<\/strong> sensibilidade de 86%\u2013100% e especificidade de 97%\u2013100% para met\u00e1stases.<\/li>\n\n\n\n<li><strong>Acesso anat\u00f4mico favor\u00e1vel:<\/strong> a adrenal esquerda \u00e9 facilmente acess\u00edvel pela parede g\u00e1strica posterior, sem estruturas cr\u00edticas interpostas.<\/li>\n\n\n\n<li><strong>Impacto cl\u00ednico:<\/strong> a confirma\u00e7\u00e3o de met\u00e1stase pode evitar cirurgias desnecess\u00e1rias e direcionar o tratamento sist\u00eamico.<\/li>\n<\/ul>\n\n\n\n<p>A bi\u00f3psia \u00e9 recomendada se<strong> tr\u00eas crit\u00e9rios forem preenchidos<\/strong>:<\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li>Exame de imagem (TC) duvidoso para les\u00e3o benigna<\/li>\n\n\n\n<li>O resultado histol\u00f3gico pode alterar o manejo cl\u00ednico<\/li>\n\n\n\n<li>Feocromocitoma exclu\u00eddo<\/li>\n<\/ol>\n\n\n\n<p>Em pacientes oncol\u00f3gicos, o exame \u00e9 \u00fatil para confirmar met\u00e1stase isolada, avaliar resposta terap\u00eautica ou redefinir estadiamento.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><br><strong>Conduta e tratamento<\/strong><\/h2>\n\n\n\n<p>O tratamento deve ser <strong>individualizado<\/strong> conforme o tipo de les\u00e3o e o perfil hormonal.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Les\u00f5es benignas e n\u00e3o funcionantes (&lt;4 cm, \u226410 UH):<\/strong> geralmente n\u00e3o requerem interven\u00e7\u00e3o nem seguimento prolongado.<\/li>\n\n\n\n<li><strong>Les\u00f5es suspeitas ou malignas:<\/strong> indicam adrenalectomia laparosc\u00f3pica. A decis\u00e3o cir\u00fargica deve considerar tamanho, crescimento, caracter\u00edsticas radiol\u00f3gicas e status funcional.<\/li>\n\n\n\n<li><strong>Met\u00e1stases adrenais confirmadas:<\/strong> podem ser tratadas com quimioterapia sist\u00eamica ou cirurgia de ressec\u00e7\u00e3o em casos selecionados.<\/li>\n<\/ul>\n\n\n\n<p>O manejo ideal \u00e9 <strong>multidisciplinar<\/strong>, envolvendo endocrinologista, radiologista, cirurgi\u00e3o e endoscopista intervencionista.<br><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Considera\u00e7\u00f5es finais<\/strong><\/h2>\n\n\n\n<p class=\"has-pale-ocean-gradient-background has-background\">Os tumores adrenais exigem avalia\u00e7\u00e3o cuidadosa para evitar tanto cirurgias desnecess\u00e1rias quanto atraso no diagn\u00f3stico de malignidades. A ecoendoscopia com FNA\/FNB pode auxiliar no diagn\u00f3stico diferencial dos tumores adrenais. No entanto, s\u00f3 deve ser indicada ap\u00f3s discusss\u00e3o multidisciplinar e a suspeita de feocromociotoma deve ser exclu\u00eddo antes da pun\u00e7\u00e3o.<\/p>\n\n\n\n<p>Veja mais sobre outros temas: <a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/como-fazer-uma-puncao-ecoguiada-transvascular\/\">Como fazer uma pun\u00e7\u00e3o ecoguiada transvascular? \u2022 Endoscopia Terapeutica<\/a><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><br><strong>Refer\u00eancias<\/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>Como citar este artigo<\/strong><\/h2>\n\n\n\n<p class=\"has-very-light-gray-to-cyan-bluish-gray-gradient-background has-background\">Mendieta PJO. Tumores Adrenais: Diagn\u00f3stico, Conduta e o Papel da Pun\u00e7\u00e3o Ecoguiada. Endoscopia Terapeutica 2025 Vol II. Dispon\u00edvel em: <a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/?p=20899\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/tumores-adrenais-diagnostico-conduta-e-o-papel-da-puncao-ecoguiada\/<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Durante exame de ecoendoscopia, a imagem a seguir foi identificada na adrenal esquerda: Diante&hellip;<\/p>\n","protected":false},"author":5965,"featured_media":20908,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[151],"tags":[409,845,357,846],"ano":[783],"tipo":[154],"volume":[147],"class_list":["post-20899","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-assuntosgerais","tag-eus","tag-incidentaloma","tag-puncao-ecoguiada","tag-tumor-adrenal","ano-783","tipo-ecoendoscopia","volume-volume-ii"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.2 (Yoast SEO v27.2) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Tumores Adrenais: Diagn\u00f3stico, Conduta e o Papel da Pun\u00e7\u00e3o Ecoguiada &#8226; 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