Citation, DOI, disclosures and article data
Citation:
Knipe H, Kearns C, Bell D, et al. Bilateral adrenal gland hyperenhancement. Reference article, Radiopaedia.org (Accessed on 05 Mar 2025) https://doi.org/10.53347/rID-28497
Bilateral adrenal gland hyperenhancement or intense adrenal enhancement is a finding on contrast-enhanced CT which can relate to hypotension, and forms part of the CT hypoperfusion complex.
The underlying mechanism is increased blood flow to the adrenal glands 7. In the arterial phase, enhancement may be peripheral only, or centrally heterogenous, and becomes homogenous in the portal venous phase 7.
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
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1. Johnson P, Fishman E. American Journal of Roentgenology. 2010;195 (1): . doi:10.2214/AJR.09.4076
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2. Venkatanarasimha N, Roobottom C. Intense adrenal enhancement: a feature of hypoperfusion complex. AJR Am J Roentgenol. 2010;195 (1): W82. doi:10.2214/AJR.09.3829 - Pubmed citation
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3. Cheung SC, Lee R, Tung HK et-al. Persistent adrenal enhancement may be the earliest CT sign of significant hypovolaemic shock. Clin Radiol. 2003;58 (4): 315-8. Pubmed citation
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4. Kanki A, Ito K, Tamada T et-al. Dynamic contrast-enhanced CT of the abdomen to predict clinical prognosis in patients with hypovolemic shock. AJR Am J Roentgenol. 2011;197 (6): W980-4. doi:10.2214/AJR.10.5736 - Pubmed citation
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5. Schek J, Macht S, Klasen-Sansone J, Heusch P, Kröpil P, Witte I, Antoch G, Lanzman RS. Clinical impact of hyperattenuation of adrenal glands on contrast-enhanced computed tomography of polytraumatised patients. (2014) European radiology. 24 (2): 527-30. doi:10.1007/s00330-013-3050-4 - Pubmed
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6.Boos J, Schek J, Kröpil P, Heusch P, Heinzler N, Antoch G, Lanzman RS. Contrast-Enhanced Computed Tomography in Intensive Care Unit Patients With Acute Clinical Deterioration: Impact of Hyperattenuating Adrenal Glands. (2017) Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes. 68 (1): 21-26. doi:10.1016/j.carj.2016.07.006 - Pubmed
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7. Di Serafino M, Viscardi D, Iacobellis F et al. Computed Tomography Imaging of Septic Shock. Beyond the Cause: The “CT Hypoperfusion Complex”. A Pictorial Essay. Insights Imaging. 2021;12(1):70. doi:10.1186/s13244-021-01006-5 - Pubmed
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