Adrenal calcification is not a rare finding in healthy asymptomatic people and is usually the result of previous hemorrhage or tuberculosis. Addison disease patients only occasionally develop calcification.
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Pathology
Etiology
Hemorrhage
- sepsis: Waterhouse-Friderichsen syndrome
- blunt abdominal trauma
- adrenal pseudocyst
- neonatal asphyxia
- coagulopathy
- infants: calcification seen soon after hemorrhage (as early as 1-2 weeks)
Infection
Adrenal tumors
- adrenal metastases, especially melanoma
- neuroblastoma
- adrenal myelolipoma
- adrenal adenoma
- adrenocortical carcinoma
- pheochromocytoma
- adrenal dermoid cyst 4
Others
-
Addison disease
- uncommon in primary Addison disease; calcification suggests an underlying cause (e.g. infection)
- Wolman disease
Radiographic features
Adrenal calcification is best assessed on CT where it can be differentiated from a calcified adrenal mass or lesion. CT also allows simultaneous characterization of any underlying lesions with size, density, enhancement, and washout.
In children, neuroblastoma has been reported as the commonest calcifying adrenal mass 4. In adults, simple calcified cysts have been reported as common adrenal masses, characteristically showing peripheral curvilinear calcification.
Post-hemorrhage calcification is usually seen after the initial adrenal hematoma has resolved and, hence, is not usually seen with an adrenal lesion. However, adrenal metastases such as from bronchogenic tumors can present with hemorrhage, making the diagnosis challenging.
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