Abdo: adrenals

Playlist contributed by: Dr Annabelle Skelley

Adrenal Calcification:

  1. Cystic disease
  2. Carcinoma
  3. Addison's disease 
  4. Ganglioneuroma 
  5. Inflammatory (Tb or histoplasmosis) 
  6. Phaeochromocytoma (egg-shell pattern, rare) 

Incidental Adrenal Mass: 

  1. Functioning tumours (Conn's adenoma, phaeochromocytoma, Cushing's adenoma, adrenal carcinoma) 
  2. Malignant (metastases, carcinoma, lymphoma, neuroblastoma) 
  3. Benign (non-functioning adenoma, myelolipoma, angiomyolipoma, cyst, post-traumatic haemorrhage, granulomatous disease) 

Functioning Adrenal Tumours

  • Conn's adenoma
    • Small 0.5-1.5cm, homogeneous low-density 
    • Hyperplasia can be nodular 
    • Excess aldosterone 
  • Phaeochromocytoma 
    • Well-circumscribed, round, 3-5cm 
    • Syndromes: MEN IIa & IIb; VHL, neuorfibromatosis, Carney syndrome, tuberous sclerosis 
    • MR: T2 heterogenously high 
    • +/- necrosis, haemorrhage, calcification
    • Hx: hypertension, palpitations, headache and biochemical (urine metanephrines) 
  • Cushing's adenoma 
    • Excess cortisol 
    • 75-80% due to adenoma secreting ACTH 

Malignant Adrenal Mass

  • Metastases: lung, breast, kidney, melanoma
    • Can be difficult to distinguish from lipid-poor adenoma on imaging 
    • Clinical history important 
    • PET/CT useful to identify FDG-avid adrenal mets
  • Lymphoma -> NHL most common 
  • Adrenal carcinoma
    • Non-functioning tumours typically large (>10 cm) at diagnosis 
    • Early invasion of IVC 
    • +/- necrosis, haemorrhage, calcification 

Benign Adrenal Mass

  • Adenoma
    • Check if functioning or not 
    • Well-circumscribed, homogenous low-density (0-20 HU) 
    • <10HU threshold -> lose signal on out of phase MR 
    • Lipid-poor adenomas best diagnosed on CT with non-con and post-con with 15-min delay 
      • Absolute washout >60% 
      • Relative washout >40%
  • Adrenal haemorrhage 
    • Homogeneous, round, non-enhancing, hyperdense (50-90HU) mass 
    • May have central cystic component if chronic 
    • Unilateral: traumatic/iatrogenic
    • Bilateral: response to shock, post-partum, burns, sepsis 
  • Adrenal cyst 
    • Well-defined, non-enhancing, water-density +/- eggshell caclfication 
  • Adrenal myelolipoma
    • Uncommon, non-functioning benign tumour 
    • Macroscopic fat interspersed with soft tissue 
    • MR: T1 high with signal loss on in/out of phase
    • US: echogenic 
  • TB
    • Heterogeneous, poorly enhancing 
    • Chronic: small calcified adrenal gland (adrenal Tb is most-common cause of Addison's in 3rd world coutnries) 

Bilateral Adrenal Mass:

  1. Metastases (lung, breast, melanoma, RCC, GIT, thyroid) 
  2. Phaeochromocytoma 
  3. Hyperplasia 
  4. Spontaneous adrenal haemorrhage 
  5. Lymphoma (rare) 
  6. Granulomatous disease (TB) 
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Playlist information

rID: 21665
Visibility: public

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