Imaging of adrenal disease

1. Adrenal glands are small and have a characteristic arrowhead shape. They can virtually always be found on CT images near the level of the celiac artery. Look for the right adrenal just posterior to the IVC and the left just anterior to the top of the left kidney.

2. Diffuse thickening of the adrenals can be due to infiltrative processes like infection, hemorrhage or lymphoma, or can be due to hyperplasia. When infiltrated, adrenal insufficiency can result which can be life-threatening.

3. Thickening of adrenals due to hyperplasia may be seen in situations where excess ACTH is present, either due to a pituitary problem, or ectopic secretion from various tumors such as small cell lung carcinoma.

3. Special MRI sequences can be used to detect intracellular fat in isolated adrenal lesions, which indicates the benign diagnosis of adrenal adenoma.

4. Adrenal metastases are very common and if extensive and bilateral can produce adrenal insufficiency. Primary adrenal cortical carcinoma is rare and can sometimes produce Cushings syndrome if the tumor secretes steroid hormones.

Click the link below to review the ACR recommendations for adrenal masses.

adrenal masses