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Everything you need to know about Computed Tomography (CT) & CT Scanning


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

  1. Spectrum of CT Findings in nonmalignant disease of the adrenal gland
    Kawashima A, Sandler CM, Fishman EK et al
    RadioGraphics 1998;18:393
  2. Primary aldosteronism:an endocrine perspective
    BlevinsLS, Wand GS
    Radiology 1992;184:599
  3. Cleveland clinic experience with adrenal Cushing’s syndrome
    Daitch JA, GoldfarbDA, NovickAC
    J Urol 1997;158:2051
© 1999-2020 Elliot K. Fishman, MD, FACR. All rights reserved.