Adrenal glands ultrasound

Adrenal glands ultrasound, is an imaging method that can provide valuable information regarding their size, shape, and structure. As a result, it can aid in diagnosing various pathological conditions related to adrenal gland function.

Techniques

Several ultrasound techniques can be employed to evaluate adrenal glands effectively. These include both transabdominal and retroperitoneal approaches, with the patient lying in the supine or prone position. The sonographer uses a high-frequency transducer to obtain cross-sectional images of the adrenal glands in different planes, enabling an accurate assessment of their size, shape, echotexture, and vascularity ^1,2.

Indications

• suspected adrenal mass or tumor

• adrenal incidentaloma discovered on other imaging studies

• workup of endocrine hypertension, such as primary hyperaldosteronism

• evaluation of suspected adrenal insufficiency or Cushing's syndrome

• assessment of pheochromocytoma or other functional adrenal disorders

Normal Findings

In healthy individuals, adrenal glands appear as homogenous hypoechoic structures with a well-defined capsule on ultrasound imaging. The normal size varies depending on age and sex but typically ranges from 3-6 cm in length and 2-4 cm in width for each gland. Both glands should have similar echogenicity without any focal masses or enlarged lymph nodes adjacent to them ^2,3.

Pathologies

• adenomas: Benign adrenal tumors usually characterized by well-defined borders and homogeneous echotexture ⁴

• adrenal hyperplasia: Enlarged and irregular adrenal glands with an increased thickness of the cortex ⁵

• cystic lesions: Including adrenal cysts, hemorrhages, or necrosis, which appear as anechoic or hypoechoic areas within the gland ⁶

• malignancies: Such as adrenocortical carcinoma or metastasis, which may present as heterogeneous masses with irregular boundaries and possible invasion of surrounding structures ⁷

Practical Points

• use a high-frequency transducer for optimal resolution

• apply appropriate patient positioning and transducer angulation for better visualization of the glands

• utilize different ultrasound planes to evaluate the entire adrenal gland comprehensively

• be cautious of possible anatomical variations that may be mistaken for pathologies

• Utilizing ultrasonography also proves to be crucial in directing fine needle aspiration procedures for the examination of suspicious lesions within the associated adrenal glands ⁸

• in cases where ultrasound findings are inconclusive or suspicious, additional imaging such as CT or MRI scans, or tissue biopsies, may be recommended ⁹