Adrenal hyperplasia

Last revised by Tariq Walizai on 5 Dec 2024

Adrenal hyperplasia refers to non-malignant growth (enlargement) of the adrenal glands.

Secondary adrenal cortical hyperplasia (i.e., ACTH-dependent, Cushing Disease) is more common and most often due to ACTH producing pituitary tumors. More rarely, it is caused by ACTH-producing small cell lung, medullary thyroid, or carcinoid tumors.

Primary cortical hyperplasia (i.e., ACTH-independent, Cushing syndrome) is much less common than secondary, with unilateral adrenal cortical adenomas being the commonest cause.

Approximately 20% of Conn syndrome cases are secondary to adrenal hyperplasia. In diffuse hyperplasia, the limbs of the adrenal glands are >5 cm in length and >10 mm in thickness. It may be unilateral in some situations 6.

Other causes include:

  • enlarged limbs of one or both adrenal glands >10 mm thick

  • normal adrenal morphology maintained

  • nodular or uniform

  • high lipid content and thus may demonstrate signal dropout on out-of-phase chemical shift imaging

  • signal dropout due to lipid content overlaps with adrenal cortical adenomas

Cases and figures

  • Case 1: due to thymic carcinoid tumor
  • Case 2: congenital adrenal hyperplasia with testicular adrenal rest tumor (TART)
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