| Problem | An incidental 3 cm adrenal lesion in a patient with no known malignancy or clinical history suggesting adrenal hyperfunction |
| Protocol | Since the concern is whether the lesion is an adenoma we will have 3 phases of acquisition and use that to have make a diagnosis |
| Pearls | - A well defined incidental adrenal lesion with an attenuation value of 10H or less on a non contrast is an adenoma. No IV contrast is needed
- A well defined incidental adrenal lesion with an attenuation value of greater than 10H needs a 3 phase adrenal protocol CT. This includes
a. Non contrast scan thru the adrenal glands
b. Inject 100 cc of iodinated contrast and acquire images at 60 seconds and 15 minutes
c. Measure the washout value to look for a 60% or greater washout to diagnose a lipid poor adenoma
d. Pitfalls: if the adrenal enhances over 120HU on the 60 second images one has to be concerned for a pheochromocytoma regardless of the washout percentage. Lab values to look for a potential pheochromocytoma are then obtained. - Pheochromocytomas enhance usually up to 170-190 HU but will have washout values of greater than 60%. This is a potential pitfall
- The Endocrine society recommends lab values for all incidental adrenal lesions as they express concern for an incidental functioning adrenal lesion.
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