Pancake adrenal gland

Case contributed by Dr Mohamed Morsi

Presentation

IUGR with oligohydramnios.

Patient Data

Age: 1 day
Gender: Male
Ultrasound

The right adrenal gland is flattened and elongated with absence of the normal shape, representing a pancake adrenal.

The right kidney is not seen in the right renal fossa or in the pelvis.

The left kidney is small in size and hyperechoic in texture.

Case Discussion

Evidence of IUGR with oligohydramnios, which are clinical indications for excluding congenital kidney disorders.

No palpable right kidney and left kidney is small by clinical examination.

Lying down adrenal sign/pancake adrenal is a feature seen usually associated with renal agenesis or renal ectopia. It is an important antenatal sonographic sign. 

On an antenatal ultrasound scan, the adrenal of the affected side appears flattened, elongated, and lying alongside the spine due to absence of the ipsilateral kidney. 

The typical radiologic appearance of an inverted Y-shaped, V-shaped, or wishbone-shaped adrenal gland depends, in part, on the presence of a kidney in the renal fossa. With renal agenesis, the ipsilateral adrenal gland will be present in the majority of cases, but the configuration of the gland, especially if it is on the left side, may assume a long slender pancake or disc shape that has been described as lying down.

The presence of a pancake adrenal gland can differentiate congenital and acquired solitary kidney in the absence of a known clinical history.

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Case information

rID: 55366
Case created: 31st Aug 2017
Last edited: 8th Sep 2017
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