Bilateral adrenal gland hyperenhancement

Last revised by Daniel J Bell on 8 Mar 2021

Bilateral adrenal gland hyperenhancement or intense adrenal enhancement may be a feature of hypotension and forms part of the CT hypoperfusion complex.

Adrenal gland hyperenhancement has been described in pediatric and small adult series or individual cases of hemorrhagic shock, pancreatitis, sepsis and trauma 1-3 but has not been demonstrated in larger series of adult patients with traumatic hypoperfusion 4

Adrenal gland hyperenhancement has been demonstrated in adult patients, in both intensive care and polytrauma settings, to be associated with an increased risk of mortality 5,6

Differential diagnosis

  • acute adrenal hemorrhage: more commonly right-sided and unilateral with an enlarged adrenal gland and associated changes in the periadrenal fat 2 

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Cases and figures

  • Case 1: secondary to bowel ischemia/infarct
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  • Case 2: hypovolemic shock
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  • Case 3: from septic shock
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  • Case 4
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