Adrenal Hyperplasia
Key Facts
- adrenal gland appearance has some variability but are classically described as inverted Y, V or T-shaped.
- width of normal adrenal gland limb is 4-9 mm and weight is around 5 grams
- width over 10 mm is consistent with hyperplasia
- adrenal hyperplasia can be unilateral or bilateral
- in hyperplasia adrenal shape is maintained
- Cushing’s syndrome is caused in 80% of cases by bilateral adrenal hyperplasia
- adrenal hyperplasia can be a result of primary hyperaldosteronism. In these cases the adrenal glands may also appear nodular
CT Findings
- enlarged limbs of one or both adrenal glands over 10mm
- no discrete mass or nodule seen except in cases of Cushings due to macronodular hyperplasia
MR Findings
- MR defines the glands within retroperitoneal fat but adds no new information to the CT Scan in these cases
Presentation
- most cases are picked up as incidental findings on a CT scans
- 30% of cases of primary hyperaldosteronism are due to bilateral adrenal hyperplasia (70% due to adenoma)
- 80% of cases of Cushing’s disease are caused by bilateral adrenal hyperplasia. Up to one-third of these cases show a normal adrenal gland based solely on CT criteria
Therapy
- in cases without clinical symptoms careful follow up is indicated
- in cases with symptoms surgery may be indicated depending on wheteher the process is unilateral or bilateral
References
- Spectrum of CT Findings in nonmalignant disease of the adrenal gland
Kawashima A, Sandler CM, Fishman EK et al
RadioGraphics 1998;18:393 - Primary aldosteronism:an endocrine perspective
BlevinsLS, Wand GS
Radiology 1992;184:599 - Cleveland clinic experience with adrenal Cushing’s syndrome
Daitch JA, GoldfarbDA, NovickAC
J Urol 1997;158:2051