Top

Published in:

01-10-2007 | Original Article

Intense adrenal enhancement in patients with acute pancreatitis and early organ failure

Authors: T. L. Bollen, H. C. van Santvoort, M. G. H. Besselink, B. van Ramshorst, H. W. van Es, H. G. Gooszen, Dutch Acute Pancreatitis Study Group

Published in: Emergency Radiology | Issue 5/2007

Abstract

Intense adrenal enhancement has previously been reported in patients with hypovolemic and septic shock. The purpose of this study was to assess whether this computed tomography (CT) finding is also observed in patients presenting with severe acute pancreatitis and early organ failure. A retrospective analysis of a prospectively collected database was performed. Out of 38 consecutive patients with predicted severe acute pancreatitis, 3 patients showed intense bilateral adrenal enhancement on early CT. All patients had early multiple organ failure and subsequently died. In two cases, pathologic correlation was obtained. Intense adrenal enhancement may be a new prognostic indicator in patients with acute pancreatitis, particularly when organ failure is present at the time of CT examination. Further studies are necessary to confirm this observation.

Sivit CJ, Taylor GA, Bulas DI et al (1992) Posttraumatic shock in children: CT findings associated with hemodynamic instability. Radiology 182:723–726PubMed

O’Hara SM, Donnelly LF (1999) Intense contrast enhancement of the adrenal glands: another abdominal CT finding associated with hypoperfusion complex in children. Am J Roentgenol 173:995–997

Cheung SC, Lee R, Tung HK et al (2003) Persistent adrenal enhancement may be the earliest CT sign of significant hypovolaemic shock. Clin Radiol 58:315–318PubMedCrossRef

Ryan MF, Hamilton PA, Sarrazin J, et al (2005) The halo sign and peripancreatic fluid: useful CT signs of hypovolaemic shock complex in adults. Clin Radiol 60:599–607PubMedCrossRef

Casey MC, McGurry S, Doyle D et al (2005) Answer to case of the month # 101. Hypovolemic shock (intense bilateral adrenal enhancement as an early prognostic indicator). Can Assoc Radiol J 56:170–172PubMed

Balthazar EJ, Robinson DL, Megibow AJ et al (1990) Acute pancreatitis: value of CT in establishing prognosis. Radiology 174:331–336PubMed

Mortele KJ, Wiesner W, Intriere L et al (2004) A modified CT severity index for evaluating acute pancreatitis: improved correlation with patient outcome. Am J Roentgenol 183:1261–1265

Besselink MG, Timmerman HM, Buskens E et al (2004) Probiotic prophylaxis in patients with predicted severe acute pancreatitis (PROPATRIA): design and rationale of a double-blind, placebo-controlled randomised multicenter trial [ISRCTN38327949]. BMC Surg 4:12PubMedCrossRef

Bradley EL III (1993) A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992. Arch Surg 128:586–590PubMed

10.

Mofidi R, Duff MD, Wigmore SJ et al (2006) Association between early systemic inflammatory response, severity of multiorgan dysfunction and death in acute pancreatitis. Br J Surg 93:738–744PubMedCrossRef

11.

Isenmann R, Rau B, Beger HG (2001) Early severe acute pancreatitis: characteristics of a new subgroup. Pancreas 22:274–278PubMedCrossRef

12.

Tao HQ, Zhang JX, Zou SC (2004) Clinical characteristics and management of patients with early acute severe pancreatitis: experience from a medical center in China. World J Gastroenterol 10:919–921PubMed

13.

Banks PA, Freeman ML (2006) Practice guidelines in acute pancreatitis. Am J Gastroenterol 101:2379–2400PubMedCrossRef

14.

Rotondo A, Angelelli G, Catalano O et al (1997) Abdominal computed tomographic findings in adults with hypovolemic shock. Emerg Radiol 4:10–15CrossRef

15.

Dellinger RP, Carlet JM, Masur H et al (2004) Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 32:858–873PubMedCrossRef

16.

Wilson PG, Manji M, Neoptolemos JP (1998) Acute pancreatitis as a model of sepsis. J Antimicrob Chemother 41(Suppl A):51–63PubMedCrossRef

17.

Burchard K (2001) A review of the adrenal cortex and severe inflammation: quest of the “eucorticoid” state. J Trauma 51:800–814PubMedCrossRef

18.

De Waele JJ, Hoste E, Decruyenaere J et al (2003) Adrenal insufficiency in severe acute pancreatitis. Pancreas 27:244–246PubMedCrossRef

Title: Intense adrenal enhancement in patients with acute pancreatitis and early organ failure
Authors: T. L. Bollen
H. C. van Santvoort
M. G. H. Besselink
B. van Ramshorst
H. W. van Es
H. G. Gooszen
Dutch Acute Pancreatitis Study Group
Publication date: 01-10-2007
Publisher: Springer-Verlag
Published in: Emergency Radiology / Issue 5/2007
Print ISSN: 1070-3004
Electronic ISSN: 1438-1435
DOI: https://doi.org/10.1007/s10140-007-0644-7

2024 ASCO Annual Meeting

Springer Medicine

Intense adrenal enhancement in patients with acute pancreatitis and early organ failure

Abstract

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 5/2007

Difficulties in the diagnosis of appendicitis: review of CT and US images

Choroid plexitis in a case of systemic nocardiosis

Interpretation of head CT scans in the emergency department by fellows versus general staff non-neuroradiologists: a closer look at the effectiveness of a quality control program

Torsion of a hyperstimulated ovary during pregnancy: a potentially difficult diagnosis

Vitamin K deficiency bleeding with intracranial hemorrhage: focus on secondary form

Scientific Abstracts Presented at the ASER 2007 Annual Scientific Meeting and Postgraduate Course October 3–6, 2007