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Bilateral adrenal abnormalities: imaging review of different entities

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Abstract

Bilateral adrenal abnormalities are not infrequently encountered during routine daily radiology practice. The differential diagnoses of bilateral adrenal abnormalities include neoplastic and non-neoplastic entities. The bilateral adrenal tumors include metastasis, lymphoma, neuroblastoma, pheochromocytoma, adenoma, and myelolipoma. Non-neoplastic bilateral adrenal masses include infectious processes and haematomas. There are different diffuse bilateral adrenal changes such as adrenal atrophy, adrenal enlargement, adrenal calcifications, and altered adrenal enhancement. In this pictorial review article, we will discuss the imaging features of these entities with emphasis on their clinical implications.

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References

  1. Kloos RT, Gross MD, Francis IR, Korobkin M, Shapiro B (1995) Incidentally discovered adrenal masses. Endocr Rev 16(4):460–484

    CAS  PubMed  Google Scholar 

  2. Mansmann G, Lau J, Balk E, et al. (2004) The clinically inapparent adrenal mass: update in diagnosis and management. Endocr Rev 25(2):309–340

    Article  PubMed  Google Scholar 

  3. Song JH, Chaudhry FS, Mayo-Smith WW (2008) The incidental adrenal mass on CT: prevalence of adrenal disease in 1,049 consecutive adrenal masses in patients with no known malignancy. AJR Am J Roentgenol 190(5):1163–1168

    Article  PubMed  Google Scholar 

  4. Zeiger MA, Siegelman SS, Hamrahian AH (2011) Medical and surgical evaluation and treatment of adrenal incidentalomas. J Clin Endocrinol Metab 96(7):2004–2015

    Article  CAS  PubMed  Google Scholar 

  5. Pasternak JD, Seib CD, Seiser N, et al. (2015) Differences between bilateral adrenal incidentalomas and unilateral lesions. JAMA Surg 150(10):974–978

    Article  PubMed  Google Scholar 

  6. Muth A, Hammarstedt L, Hellstrom M, et al. (2011) Cohort study of patients with adrenal lesions discovered incidentally. Br J Surg 98(10):1383–1391

    Article  CAS  PubMed  Google Scholar 

  7. Zhou J, Ye D, Wu M, et al. (2009) Bilateral adrenal tumor: causes and clinical features in eighteen cases. Int Urol Nephrol 41(3):547–551

    Article  PubMed  Google Scholar 

  8. Gupta P, Bhalla A, Sharma R (2012) Bilateral adrenal lesions. J Med Imaging Radiat Oncol 56(6):636–645

    Article  PubMed  Google Scholar 

  9. Lomte N, Bandgar T, Khare S, et al. (2016) Bilateral adrenal masses: a single-centre experience. Endocr Connect 5(2):92–100

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Johnson PT, Horton KM, Fishman EK (2009) Adrenal imaging with multidetector CT: evidence-based protocol optimization and interpretative practice. Radiographics 29(5):1319–1331

    Article  PubMed  Google Scholar 

  11. Choyke PL, Doppman JL (2000) Case 18: adrenocorticotropic hormone-dependent Cushing syndrome. Radiology 214(1):195–198

    Article  CAS  PubMed  Google Scholar 

  12. Siegelman ES (2012) Adrenal MRI: techniques and clinical applications. J Magn Reson Imaging 36(2):272–285

    Article  PubMed  Google Scholar 

  13. Kahn SL, Angle JF (2010) Adrenal vein sampling. Tech Vasc Interv Radiol 13(2):110–125

    Article  PubMed  Google Scholar 

  14. Taffel M, Haji-Momenian S, Nikolaidis P, Miller FH (2012) Adrenal imaging: a comprehensive review. Radiol Clin North Am 50(2):219–243

    Article  PubMed  Google Scholar 

  15. Schieda N, Siegelman ES (2017) Update on CT and MRI of adrenal nodules. AJR Am J Roentgenol 208(6):1206–1217

    Article  PubMed  Google Scholar 

  16. Boland GW, Lee MJ, Gazelle GS, et al. (1998) Characterization of adrenal masses using unenhanced CT: an analysis of the CT literature. AJR Am J Roentgenol 171(1):201–204

    Article  CAS  PubMed  Google Scholar 

  17. Korobkin M, Giordano TJ, Brodeur FJ, et al. (1996) Adrenal adenomas: relationship between histologic lipid and CT and MR findings. Radiology 200(3):743–747

    Article  CAS  PubMed  Google Scholar 

  18. Caoili EM, Korobkin M, Francis IR, Cohan RH, Dunnick NR (2000) Delayed enhanced CT of lipid-poor adrenal adenomas. AJR Am J Roentgenol 175(5):1411–1415

    Article  CAS  PubMed  Google Scholar 

  19. Tariq U, Poder L, Carlson D, et al. (2012) Multimodality imaging of fat-containing adrenal metastasis from hepatocellular carcinoma. Clin Nucl Med 37(6):e157–e159

    Article  PubMed  Google Scholar 

  20. Choi YA, Kim CK, Park BK, Kim B (2013) Evaluation of adrenal metastases from renal cell carcinoma and hepatocellular carcinoma: use of delayed contrast-enhanced CT. Radiology 266(2):514–520

    Article  PubMed  Google Scholar 

  21. Moosavi B, Shabana WM, El-Khodary M, et al. (2016) Intracellular lipid in clear cell renal cell carcinoma tumor thrombus and metastases detected by chemical shift (in and opposed phase) MRI: radiologic–pathologic correlation. Acta Radiol 57(2):241–248

    Article  PubMed  Google Scholar 

  22. Lam KY, Lo CY (2002) Metastatic tumours of the adrenal glands: a 30-year experience in a teaching hospital. Clin Endocrinol 56(1):95–101

    Article  Google Scholar 

  23. Sasaguri K, Takahashi N, Takeuchi M, et al. (2016) Differentiation of benign from metastatic adrenal masses in patients with renal cell carcinoma on contrast-enhanced CT. AJR Am J Roentgenol 207(5):1031–1038

    Article  PubMed  Google Scholar 

  24. Schieda N, Krishna S, McInnes MDF, et al. (2017) Utility of MRI to differentiate clear cell renal cell carcinoma adrenal metastases from adrenal adenomas. AJR Am J Roentgenol 209(3):W152–W159

    Article  PubMed  Google Scholar 

  25. Tsushima Y, Takahashi-Taketomi A, Endo K (2009) Diagnostic utility of diffusion-weighted MR imaging and apparent diffusion coefficient value for the diagnosis of adrenal tumors. J Magn Reson Imaging 29(1):112–117

    Article  PubMed  Google Scholar 

  26. Vikram R, Yeung HD, Macapinlac HA, Iyer RB (2008) Utility of PET/CT in differentiating benign from malignant adrenal nodules in patients with cancer. AJR Am J Roentgenol 191(5):1545–1551

    Article  PubMed  Google Scholar 

  27. Boland GW, Blake MA, Holalkere NS, Hahn PF (2009) PET/CT for the characterization of adrenal masses in patients with cancer: qualitative versus quantitative accuracy in 150 consecutive patients. AJR Am J Roentgenol 192(4):956–962

    Article  PubMed  Google Scholar 

  28. Singh D, Kumar L, Sharma A, et al. (2004) Adrenal involvement in non-Hodgkin’s lymphoma: four cases and review of literature. Leuk Lymphoma 45(4):789–794

    Article  PubMed  Google Scholar 

  29. Zhou L, Peng W, Wang C, et al. (2012) Primary adrenal lymphoma: radiological; pathological, clinical correlation. Eur J Radiol 81(3):401–405

    Article  PubMed  Google Scholar 

  30. Paling MR, Williamson BR (1983) Adrenal involvement in non-Hodgkin lymphoma. AJR Am J Roentgenol 141(2):303–305

    Article  CAS  PubMed  Google Scholar 

  31. Kato H, Itami J, Shiina T, et al. (1996) MR imaging of primary adrenal lymphoma. Clin Imaging 20(2):126–128

    Article  CAS  PubMed  Google Scholar 

  32. Metser U, Miller E, Lerman H, et al. (2006) 18F-FDG PET/CT in the evaluation of adrenal masses. J Nucl Med 47(1):32–37

    PubMed  Google Scholar 

  33. Lo Cunsolo C, Casciano I, Gambini C, et al. (2001) Molecular alterations in a case of bilateral adrenal neuroblastoma. Med Pediatr Oncol 36(4):491–493

    Article  CAS  PubMed  Google Scholar 

  34. Schleiermacher G, Rubie H, Hartmann O, et al. (2003) Treatment of stage 4s neuroblastoma—report of 10 years’ experience of the French Society of Paediatric Oncology (SFOP). Br J Cancer 89(3):470–476

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Hiorns MP, Owens CM (2001) Radiology of neuroblastoma in children. Eur Radiol 11(10):2071–2081

    Article  CAS  PubMed  Google Scholar 

  36. Amar L, Bertherat J, Baudin E, et al. (2005) Genetic testing in pheochromocytoma or functional paraganglioma. J Clin Oncol 23(34):8812–8818

    Article  CAS  PubMed  Google Scholar 

  37. Caoili EM, Korobkin M, Francis IR, et al. (2002) Adrenal masses: characterization with combined unenhanced and delayed enhanced CT. Radiology 222(3):629–633

    Article  PubMed  Google Scholar 

  38. Blake MA, Kalra MK, Maher MM, et al. (2004) Pheochromocytoma: an imaging chameleon. Radiographics 24(1):S87–S99

    Article  PubMed  Google Scholar 

  39. Blake MA, Krishnamoorthy SK, Boland GW, et al. (2003) Low-density pheochromocytoma on CT: a mimicker of adrenal adenoma. AJR Am J Roentgenol 181(6):1663–1668

    Article  PubMed  Google Scholar 

  40. Rozovsky K, Koplewitz BZ, Krausz Y, et al. (2008) Added value of SPECT/CT for correlation of MIBG scintigraphy and diagnostic CT in neuroblastoma and pheochromocytoma. AJR Am J Roentgenol 190(4):1085–1090

    Article  PubMed  Google Scholar 

  41. Han M, Burnett AL, Fishman EK, Marshall FF (1997) The natural history and treatment of adrenal myelolipoma. J Urol 157(4):1213–1216

    Article  CAS  PubMed  Google Scholar 

  42. Kalidindi RS, Hattingh L (2006) Bilateral giant adrenal myelolipomas. Abdom Imaging 31(1):125–127

    Article  CAS  PubMed  Google Scholar 

  43. Kenney PJ, Wagner BJ, Rao P, Heffess CS (1998) Myelolipoma: CT and pathologic features. Radiology 208(1):87–95

    Article  CAS  PubMed  Google Scholar 

  44. Zhang HM, Perrier ND, Grubbs EG, et al. (2012) CT features and quantification of the characteristics of adrenocortical carcinomas on unenhanced and contrast-enhanced studies. Clin Radiol 67(1):38–46

    Article  CAS  PubMed  Google Scholar 

  45. Otal P, Escourrou G, Mazerolles C, et al. (1999) Imaging features of uncommon adrenal masses with histopathologic correlation. Radiographics 19(3):569–581

    Article  CAS  PubMed  Google Scholar 

  46. Guo YK, Yang ZG, Li Y, et al. (2007) Addison’s disease due to adrenal tuberculosis: contrast-enhanced CT features and clinical duration correlation. Eur J Radiol 62(1):126–131

    Article  PubMed  Google Scholar 

  47. Wang YX, Chen CR, He GX, Tang AR (1998) CT findings of adrenal glands in patients with tuberculous Addison’s disease. J Belge Radiol 81(5):226–228

    CAS  PubMed  Google Scholar 

  48. Efremidis SC, Harsoulis F, Douma S, et al. (1996) Adrenal insufficiency with enlarged adrenals. Abdom Imaging 21(2):168–171

    Article  CAS  PubMed  Google Scholar 

  49. Yang ZG, Guo YK, Li Y, et al. (2006) Differentiation between tuberculosis and primary tumors in the adrenal gland: evaluation with contrast-enhanced CT. Eur Radiol 16(9):2031–2036

    Article  PubMed  Google Scholar 

  50. Vita JA, Silverberg SJ, Goland RS, Austin JH, Knowlton AI (1985) Clinical clues to the cause of Addison’s disease. Am J Med 78(3):461–466

    Article  CAS  PubMed  Google Scholar 

  51. Kelestimur F, Unlu Y, Ozesmi M, Tolu I (1994) A hormonal and radiological evaluation of adrenal gland in patients with acute or chronic pulmonary tuberculosis. Clin Endocrinol 41(1):53–56

    Article  CAS  Google Scholar 

  52. Kumar N, Singh S, Govil S (2003) Adrenal histoplasmosis: clinical presentation and imaging features in nine cases. Abdom Imaging 28(5):703–708

    Article  CAS  PubMed  Google Scholar 

  53. Kawashima A, Sandler CM, Ernst RD, et al. (1999) Imaging of nontraumatic hemorrhage of the adrenal gland. Radiographics 19(4):949–963

    Article  CAS  PubMed  Google Scholar 

  54. Rana AI, Kenney PJ, Lockhart ME, et al. (2004) Adrenal gland hematomas in trauma patients. Radiology 230(3):669–675

    Article  PubMed  Google Scholar 

  55. Jordan E, Poder L, Courtier J, et al. (2012) Imaging of nontraumatic adrenal hemorrhage. AJR Am J Roentgenol 199(1):W91–W98

    Article  PubMed  Google Scholar 

  56. Tan GX, Sutherland T (2016) Adrenal congestion preceding adrenal hemorrhage on CT imaging: a case series. Abdom Radiol 41(2):303–310

    Article  Google Scholar 

  57. Aljabri KS, Bokhari SA, Alkeraithi M (2011) Adrenal hemangioma in a 19-year-old female. Ann Saudi Med 31(4):421–423

    Article  PubMed  PubMed Central  Google Scholar 

  58. Young SA, Shapiro B (1998) Klippel-Trenaunay-Weber syndrome with adrenal pseudocyst: characterization by blood pool and adrenocortical iodocholesterol scintigraphy. Clin Nucl Med 23(8):528–531

    Article  PubMed  Google Scholar 

  59. Ojili V, Tirumani SH, Gunabushanam G, et al. (2013) Abdominal hemangiomas: a pictorial review of unusual, atypical, and rare types. Can Assoc Radiol J 64(1):18–27

    Article  PubMed  Google Scholar 

  60. Doppman JL, Gill JR Jr, Nienhuis AW, Earll JM, Long JA Jr (1982) CT findings in Addison’s disease. J Comput Assist Tomogr 6(4):757–761

    Article  CAS  PubMed  Google Scholar 

  61. Sohaib SA, Hanson JA, Newell-Price JD, et al. (1999) CT appearance of the adrenal glands in adrenocorticotrophic hormone-dependent Cushing’s syndrome. AJR Am J Roentgenol 172(4):997–1002

    Article  CAS  PubMed  Google Scholar 

  62. Lingam RK, Sohaib SA, Vlahos I, et al. (2003) CT of primary hyperaldosteronism (Conn’s syndrome): the value of measuring the adrenal gland. AJR Am J Roentgenol 181(3):843–849

    Article  CAS  PubMed  Google Scholar 

  63. Rockall AG, Babar SA, Sohaib SA, et al. (2004) CT and MR imaging of the adrenal glands in ACTH-independent cushing syndrome. Radiographics 24(2):435–452

    Article  PubMed  Google Scholar 

  64. Michelle MA, Jensen CT, Habra MA, et al. (2017) Adrenal cortical hyperplasia: diagnostic workup, subtypes, imaging features and mimics. Br J Radiol 90(1079):14

    Article  Google Scholar 

  65. Verma A, Mohan S, Gupta A (2008) ACTH-independent macronodular adrenal hyperplasia: imaging findings of a rare condition: a case report. Abdom Imaging 33(2):225–229

    Article  PubMed  Google Scholar 

  66. Kawashima A, Sandler CM, Fishman EK, et al. (1998) Spectrum of CT findings in nonmalignant disease of the adrenal gland. Radiographics 18(2):393–412

    Article  CAS  PubMed  Google Scholar 

  67. Al Essa M, Nounou R, Sakati N, et al. (1998) Wolman’s disease: the King Faisal Specialist Hospital and Research Centre experience. Ann Saudi Med 18(2):120–124

    Article  CAS  PubMed  Google Scholar 

  68. Sen D, Satija L, Saxena S, Rastogi V, Singh M (2015) A rare constellation of imaging findings in Wolman disease. Med J Armed Forces India 71(Suppl 2):26

    Google Scholar 

  69. Westra SJ, Zaninovic AC, Hall TR, Kangarloo H, Boechat MI (1994) Imaging of the adrenal gland in children. Radiographics 14(6):1323–1340

    Article  CAS  PubMed  Google Scholar 

  70. O’Hara SM, Donnelly LF (1999) Intense contrast enhancement of the adrenal glands: another abdominal CT finding associated with hypoperfusion complex in children. AJR Am J Roentgenol 173(4):995–997

    Article  PubMed  Google Scholar 

  71. Espinosa G, Santos E, Cervera R, et al. (2003) Adrenal involvement in the antiphospholipid syndrome: clinical and immunologic characteristics of 86 patients. Medicine 82(2):106–118

    Article  PubMed  Google Scholar 

  72. Inam S, Sidki K, al-Marshedy AR, Judzewitsch R (1991) Addison’s disease, hypertension, renal and hepatic microthrombosis in ‘primary’ antiphospholipid syndrome. Postgrad Med J 67(786):385–388

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  73. Riddell AM, Khalili K (2004) Sequential adrenal infarction without MRI-detectable hemorrhage in primary antiphospholipid–antibody syndrome. AJR Am J Roentgenol 183(1):220–222

    Article  CAS  PubMed  Google Scholar 

  74. Ames DE, Asherson RA, Ayres B, Cassar J, Hughes GR (1992) Bilateral adrenal infarction, hypoadrenalism and splinter haemorrhages in the ‘primary’ antiphospholipid syndrome. Br J Rheumatol 31(2):117–120

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, King Faisal Specialist Hospital and Research Center, MBC-28, P.O. Box 3354, Riyadh, 11211, Saudi Arabia

    Meshal Ali Alshahrani, Mnahi Bin Saeedan, Tariq Alkhunaizan & Ibtisam Musallam Aljohani

  2. National Guard Health Affairs, King Abdulaziz Medical City, Medical Imaging Department, Riyadh, Saudi Arabia

    Fahad Mohammed Azzumeea

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  1. Meshal Ali Alshahrani
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  2. Mnahi Bin Saeedan
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Correspondence to Mnahi Bin Saeedan.

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This study was not supported by grant funding. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Alshahrani, M.A., Bin Saeedan, M., Alkhunaizan, T. et al. Bilateral adrenal abnormalities: imaging review of different entities. Abdom Radiol 44, 154–179 (2019). https://doi.org/10.1007/s00261-018-1670-5

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