Top

Published in:

01-01-2019 | Pictorial essay

Bilateral adrenal abnormalities: imaging review of different entities

Authors: Meshal Ali Alshahrani, Mnahi Bin Saeedan, Tariq Alkhunaizan, Ibtisam Musallam Aljohani, Fahad Mohammed Azzumeea

Published in: Abdominal Radiology | Issue 1/2019

Abstract

Bilateral adrenal abnormalities are not infrequently encountered during routine daily radiology practice. The differential diagnoses of bilateral adrenal abnormalities include neoplastic and non-neoplastic entities. The bilateral adrenal tumors include metastasis, lymphoma, neuroblastoma, pheochromocytoma, adenoma, and myelolipoma. Non-neoplastic bilateral adrenal masses include infectious processes and haematomas. There are different diffuse bilateral adrenal changes such as adrenal atrophy, adrenal enlargement, adrenal calcifications, and altered adrenal enhancement. In this pictorial review article, we will discuss the imaging features of these entities with emphasis on their clinical implications.

Available only for authorised users

Kloos RT, Gross MD, Francis IR, Korobkin M, Shapiro B (1995) Incidentally discovered adrenal masses. Endocr Rev 16(4):460–484PubMed

Mansmann G, Lau J, Balk E, et al. (2004) The clinically inapparent adrenal mass: update in diagnosis and management. Endocr Rev 25(2):309–340PubMedCrossRef

Song JH, Chaudhry FS, Mayo-Smith WW (2008) The incidental adrenal mass on CT: prevalence of adrenal disease in 1,049 consecutive adrenal masses in patients with no known malignancy. AJR Am J Roentgenol 190(5):1163–1168PubMedCrossRef

Zeiger MA, Siegelman SS, Hamrahian AH (2011) Medical and surgical evaluation and treatment of adrenal incidentalomas. J Clin Endocrinol Metab 96(7):2004–2015PubMedCrossRef

Pasternak JD, Seib CD, Seiser N, et al. (2015) Differences between bilateral adrenal incidentalomas and unilateral lesions. JAMA Surg 150(10):974–978PubMedCrossRef

Muth A, Hammarstedt L, Hellstrom M, et al. (2011) Cohort study of patients with adrenal lesions discovered incidentally. Br J Surg 98(10):1383–1391PubMedCrossRef

Zhou J, Ye D, Wu M, et al. (2009) Bilateral adrenal tumor: causes and clinical features in eighteen cases. Int Urol Nephrol 41(3):547–551PubMedCrossRef

Gupta P, Bhalla A, Sharma R (2012) Bilateral adrenal lesions. J Med Imaging Radiat Oncol 56(6):636–645PubMedCrossRef

Lomte N, Bandgar T, Khare S, et al. (2016) Bilateral adrenal masses: a single-centre experience. Endocr Connect 5(2):92–100PubMedPubMedCentralCrossRef

10.

Johnson PT, Horton KM, Fishman EK (2009) Adrenal imaging with multidetector CT: evidence-based protocol optimization and interpretative practice. Radiographics 29(5):1319–1331PubMedCrossRef

11.

Choyke PL, Doppman JL (2000) Case 18: adrenocorticotropic hormone-dependent Cushing syndrome. Radiology 214(1):195–198PubMedCrossRef

12.

Siegelman ES (2012) Adrenal MRI: techniques and clinical applications. J Magn Reson Imaging 36(2):272–285PubMedCrossRef

13.

Kahn SL, Angle JF (2010) Adrenal vein sampling. Tech Vasc Interv Radiol 13(2):110–125PubMedCrossRef

14.

Taffel M, Haji-Momenian S, Nikolaidis P, Miller FH (2012) Adrenal imaging: a comprehensive review. Radiol Clin North Am 50(2):219–243PubMedCrossRef

15.

Schieda N, Siegelman ES (2017) Update on CT and MRI of adrenal nodules. AJR Am J Roentgenol 208(6):1206–1217PubMedCrossRef

16.

Boland GW, Lee MJ, Gazelle GS, et al. (1998) Characterization of adrenal masses using unenhanced CT: an analysis of the CT literature. AJR Am J Roentgenol 171(1):201–204PubMedCrossRef

17.

Korobkin M, Giordano TJ, Brodeur FJ, et al. (1996) Adrenal adenomas: relationship between histologic lipid and CT and MR findings. Radiology 200(3):743–747PubMedCrossRef

18.

Caoili EM, Korobkin M, Francis IR, Cohan RH, Dunnick NR (2000) Delayed enhanced CT of lipid-poor adrenal adenomas. AJR Am J Roentgenol 175(5):1411–1415PubMedCrossRef

19.

Tariq U, Poder L, Carlson D, et al. (2012) Multimodality imaging of fat-containing adrenal metastasis from hepatocellular carcinoma. Clin Nucl Med 37(6):e157–e159PubMedCrossRef

20.

Choi YA, Kim CK, Park BK, Kim B (2013) Evaluation of adrenal metastases from renal cell carcinoma and hepatocellular carcinoma: use of delayed contrast-enhanced CT. Radiology 266(2):514–520PubMedCrossRef

21.

Moosavi B, Shabana WM, El-Khodary M, et al. (2016) Intracellular lipid in clear cell renal cell carcinoma tumor thrombus and metastases detected by chemical shift (in and opposed phase) MRI: radiologic–pathologic correlation. Acta Radiol 57(2):241–248PubMedCrossRef

22.

Lam KY, Lo CY (2002) Metastatic tumours of the adrenal glands: a 30-year experience in a teaching hospital. Clin Endocrinol 56(1):95–101CrossRef

23.

Sasaguri K, Takahashi N, Takeuchi M, et al. (2016) Differentiation of benign from metastatic adrenal masses in patients with renal cell carcinoma on contrast-enhanced CT. AJR Am J Roentgenol 207(5):1031–1038PubMedCrossRef

24.

Schieda N, Krishna S, McInnes MDF, et al. (2017) Utility of MRI to differentiate clear cell renal cell carcinoma adrenal metastases from adrenal adenomas. AJR Am J Roentgenol 209(3):W152–W159PubMedCrossRef

25.

Tsushima Y, Takahashi-Taketomi A, Endo K (2009) Diagnostic utility of diffusion-weighted MR imaging and apparent diffusion coefficient value for the diagnosis of adrenal tumors. J Magn Reson Imaging 29(1):112–117PubMedCrossRef

26.

Vikram R, Yeung HD, Macapinlac HA, Iyer RB (2008) Utility of PET/CT in differentiating benign from malignant adrenal nodules in patients with cancer. AJR Am J Roentgenol 191(5):1545–1551PubMedCrossRef

27.

Boland GW, Blake MA, Holalkere NS, Hahn PF (2009) PET/CT for the characterization of adrenal masses in patients with cancer: qualitative versus quantitative accuracy in 150 consecutive patients. AJR Am J Roentgenol 192(4):956–962PubMedCrossRef

28.

Singh D, Kumar L, Sharma A, et al. (2004) Adrenal involvement in non-Hodgkin’s lymphoma: four cases and review of literature. Leuk Lymphoma 45(4):789–794PubMedCrossRef

29.

Zhou L, Peng W, Wang C, et al. (2012) Primary adrenal lymphoma: radiological; pathological, clinical correlation. Eur J Radiol 81(3):401–405PubMedCrossRef

30.

Paling MR, Williamson BR (1983) Adrenal involvement in non-Hodgkin lymphoma. AJR Am J Roentgenol 141(2):303–305PubMedCrossRef

31.

Kato H, Itami J, Shiina T, et al. (1996) MR imaging of primary adrenal lymphoma. Clin Imaging 20(2):126–128PubMedCrossRef

32.

Metser U, Miller E, Lerman H, et al. (2006) 18F-FDG PET/CT in the evaluation of adrenal masses. J Nucl Med 47(1):32–37PubMed

33.

Lo Cunsolo C, Casciano I, Gambini C, et al. (2001) Molecular alterations in a case of bilateral adrenal neuroblastoma. Med Pediatr Oncol 36(4):491–493PubMedCrossRef

34.

Schleiermacher G, Rubie H, Hartmann O, et al. (2003) Treatment of stage 4s neuroblastoma—report of 10 years’ experience of the French Society of Paediatric Oncology (SFOP). Br J Cancer 89(3):470–476PubMedPubMedCentralCrossRef

35.

Hiorns MP, Owens CM (2001) Radiology of neuroblastoma in children. Eur Radiol 11(10):2071–2081PubMedCrossRef

36.

Amar L, Bertherat J, Baudin E, et al. (2005) Genetic testing in pheochromocytoma or functional paraganglioma. J Clin Oncol 23(34):8812–8818PubMedCrossRef

37.

Caoili EM, Korobkin M, Francis IR, et al. (2002) Adrenal masses: characterization with combined unenhanced and delayed enhanced CT. Radiology 222(3):629–633PubMedCrossRef

38.

Blake MA, Kalra MK, Maher MM, et al. (2004) Pheochromocytoma: an imaging chameleon. Radiographics 24(1):S87–S99PubMedCrossRef

39.

Blake MA, Krishnamoorthy SK, Boland GW, et al. (2003) Low-density pheochromocytoma on CT: a mimicker of adrenal adenoma. AJR Am J Roentgenol 181(6):1663–1668PubMedCrossRef

40.

Rozovsky K, Koplewitz BZ, Krausz Y, et al. (2008) Added value of SPECT/CT for correlation of MIBG scintigraphy and diagnostic CT in neuroblastoma and pheochromocytoma. AJR Am J Roentgenol 190(4):1085–1090PubMedCrossRef

41.

Han M, Burnett AL, Fishman EK, Marshall FF (1997) The natural history and treatment of adrenal myelolipoma. J Urol 157(4):1213–1216PubMedCrossRef

42.

Kalidindi RS, Hattingh L (2006) Bilateral giant adrenal myelolipomas. Abdom Imaging 31(1):125–127PubMedCrossRef

43.

Kenney PJ, Wagner BJ, Rao P, Heffess CS (1998) Myelolipoma: CT and pathologic features. Radiology 208(1):87–95PubMedCrossRef

44.

Zhang HM, Perrier ND, Grubbs EG, et al. (2012) CT features and quantification of the characteristics of adrenocortical carcinomas on unenhanced and contrast-enhanced studies. Clin Radiol 67(1):38–46PubMedCrossRef

45.

Otal P, Escourrou G, Mazerolles C, et al. (1999) Imaging features of uncommon adrenal masses with histopathologic correlation. Radiographics 19(3):569–581PubMedCrossRef

46.

Guo YK, Yang ZG, Li Y, et al. (2007) Addison’s disease due to adrenal tuberculosis: contrast-enhanced CT features and clinical duration correlation. Eur J Radiol 62(1):126–131PubMedCrossRef

47.

Wang YX, Chen CR, He GX, Tang AR (1998) CT findings of adrenal glands in patients with tuberculous Addison’s disease. J Belge Radiol 81(5):226–228PubMed

48.

Efremidis SC, Harsoulis F, Douma S, et al. (1996) Adrenal insufficiency with enlarged adrenals. Abdom Imaging 21(2):168–171PubMedCrossRef

49.

Yang ZG, Guo YK, Li Y, et al. (2006) Differentiation between tuberculosis and primary tumors in the adrenal gland: evaluation with contrast-enhanced CT. Eur Radiol 16(9):2031–2036PubMedCrossRef

50.

Vita JA, Silverberg SJ, Goland RS, Austin JH, Knowlton AI (1985) Clinical clues to the cause of Addison’s disease. Am J Med 78(3):461–466PubMedCrossRef

51.

Kelestimur F, Unlu Y, Ozesmi M, Tolu I (1994) A hormonal and radiological evaluation of adrenal gland in patients with acute or chronic pulmonary tuberculosis. Clin Endocrinol 41(1):53–56CrossRef

52.

Kumar N, Singh S, Govil S (2003) Adrenal histoplasmosis: clinical presentation and imaging features in nine cases. Abdom Imaging 28(5):703–708PubMedCrossRef

53.

Kawashima A, Sandler CM, Ernst RD, et al. (1999) Imaging of nontraumatic hemorrhage of the adrenal gland. Radiographics 19(4):949–963PubMedCrossRef

54.

Rana AI, Kenney PJ, Lockhart ME, et al. (2004) Adrenal gland hematomas in trauma patients. Radiology 230(3):669–675PubMedCrossRef

55.

Jordan E, Poder L, Courtier J, et al. (2012) Imaging of nontraumatic adrenal hemorrhage. AJR Am J Roentgenol 199(1):W91–W98PubMedCrossRef

56.

Tan GX, Sutherland T (2016) Adrenal congestion preceding adrenal hemorrhage on CT imaging: a case series. Abdom Radiol 41(2):303–310CrossRef

57.

Aljabri KS, Bokhari SA, Alkeraithi M (2011) Adrenal hemangioma in a 19-year-old female. Ann Saudi Med 31(4):421–423PubMedPubMedCentralCrossRef

58.

Young SA, Shapiro B (1998) Klippel-Trenaunay-Weber syndrome with adrenal pseudocyst: characterization by blood pool and adrenocortical iodocholesterol scintigraphy. Clin Nucl Med 23(8):528–531PubMedCrossRef

59.

Ojili V, Tirumani SH, Gunabushanam G, et al. (2013) Abdominal hemangiomas: a pictorial review of unusual, atypical, and rare types. Can Assoc Radiol J 64(1):18–27PubMedCrossRef

60.

Doppman JL, Gill JR Jr, Nienhuis AW, Earll JM, Long JA Jr (1982) CT findings in Addison’s disease. J Comput Assist Tomogr 6(4):757–761PubMedCrossRef

61.

Sohaib SA, Hanson JA, Newell-Price JD, et al. (1999) CT appearance of the adrenal glands in adrenocorticotrophic hormone-dependent Cushing’s syndrome. AJR Am J Roentgenol 172(4):997–1002PubMedCrossRef

62.

Lingam RK, Sohaib SA, Vlahos I, et al. (2003) CT of primary hyperaldosteronism (Conn’s syndrome): the value of measuring the adrenal gland. AJR Am J Roentgenol 181(3):843–849PubMedCrossRef

63.

Rockall AG, Babar SA, Sohaib SA, et al. (2004) CT and MR imaging of the adrenal glands in ACTH-independent cushing syndrome. Radiographics 24(2):435–452PubMedCrossRef

64.

Michelle MA, Jensen CT, Habra MA, et al. (2017) Adrenal cortical hyperplasia: diagnostic workup, subtypes, imaging features and mimics. Br J Radiol 90(1079):14CrossRef

65.

Verma A, Mohan S, Gupta A (2008) ACTH-independent macronodular adrenal hyperplasia: imaging findings of a rare condition: a case report. Abdom Imaging 33(2):225–229PubMedCrossRef

66.

Kawashima A, Sandler CM, Fishman EK, et al. (1998) Spectrum of CT findings in nonmalignant disease of the adrenal gland. Radiographics 18(2):393–412PubMedCrossRef

67.

Al Essa M, Nounou R, Sakati N, et al. (1998) Wolman’s disease: the King Faisal Specialist Hospital and Research Centre experience. Ann Saudi Med 18(2):120–124PubMedCrossRef

68.

Sen D, Satija L, Saxena S, Rastogi V, Singh M (2015) A rare constellation of imaging findings in Wolman disease. Med J Armed Forces India 71(Suppl 2):26

69.

Westra SJ, Zaninovic AC, Hall TR, Kangarloo H, Boechat MI (1994) Imaging of the adrenal gland in children. Radiographics 14(6):1323–1340PubMedCrossRef

70.

O’Hara SM, Donnelly LF (1999) Intense contrast enhancement of the adrenal glands: another abdominal CT finding associated with hypoperfusion complex in children. AJR Am J Roentgenol 173(4):995–997PubMedCrossRef

71.

Espinosa G, Santos E, Cervera R, et al. (2003) Adrenal involvement in the antiphospholipid syndrome: clinical and immunologic characteristics of 86 patients. Medicine 82(2):106–118PubMedCrossRef

72.

Inam S, Sidki K, al-Marshedy AR, Judzewitsch R (1991) Addison’s disease, hypertension, renal and hepatic microthrombosis in ‘primary’ antiphospholipid syndrome. Postgrad Med J 67(786):385–388PubMedPubMedCentralCrossRef

73.

Riddell AM, Khalili K (2004) Sequential adrenal infarction without MRI-detectable hemorrhage in primary antiphospholipid–antibody syndrome. AJR Am J Roentgenol 183(1):220–222PubMedCrossRef

74.

Ames DE, Asherson RA, Ayres B, Cassar J, Hughes GR (1992) Bilateral adrenal infarction, hypoadrenalism and splinter haemorrhages in the ‘primary’ antiphospholipid syndrome. Br J Rheumatol 31(2):117–120PubMedCrossRef

Title: Bilateral adrenal abnormalities: imaging review of different entities
Authors: Meshal Ali Alshahrani
Mnahi Bin Saeedan
Tariq Alkhunaizan
Ibtisam Musallam Aljohani
Fahad Mohammed Azzumeea
Publication date: 01-01-2019
Publisher: Springer US
Published in: Abdominal Radiology / Issue 1/2019
Print ISSN: 2366-004X
Electronic ISSN: 2366-0058
DOI: https://doi.org/10.1007/s00261-018-1670-5

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Bilateral adrenal abnormalities: imaging review of different entities

Abstract

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2019

CT colonography screening in extracolonic cancer survivors: impact on rates of colorectal and extracolonic findings by cancer type

Lobular breast cancer: patterns of intraabdominal metastatic spread on imaging and prognostic significance

Indirect percutaneous core needle biopsy of solid pancreatic or peripancreatic lesions

Coral-reef-aorta

Computed tomographic features of abdominal tuberculosis: unmask the impersonator!

Ureteral pseudodiverticulosis and urothelial cell carcinoma: rethinking the association

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page