Adrenocortical hyperplasia: a review of clinical presentation and imaging

  • Ajaykumar C. Morani
  • Corey T. JensenEmail author
  • Mouhammed Amir Habra
  • Michelle M. Agrons
  • Christine O. Menias
  • Nicolaus A. Wagner-Bartak
  • Akram M. Shaaban
  • Alicia M. Roman-Colon
  • Khaled M. Elsayes
Special Section: Adrenal Gland


Adrenal hyperplasia is non-malignant enlargement of the adrenal glands, which is often bilateral. It can be incidental or related to indolent disease process and may be related to benign or malignant etiologies causing biochemical alterations in the hypothalamic–pituitary–adrenal axis which controls steroidogenesis and in particular cortisol production. Clinical significance of the adrenal hyperplasia is variable ranging from asymptomatic finding to serious manifestations of Cushing syndrome. This is often associated with anatomical changes in the adrenal glands, which typically manifests as diffuse and sometimes nodular enlargement of the adrenal glands radiologically. Approaching adrenal hyperplasia requires careful clinical and biochemical evaluation in correlation with imaging review to differentiate ACTH-dependent and ACTH-independent etiologies. CT is the primary modality of choice for adult adrenal imaging owing to reproducibility, temporal and spatial resolution and broader access, while MRI often serves a complimentary role. Ultrasound and MRI are most commonly used in pediatric cases to evaluate congenital adrenal hyperplasia. This article will discuss the clinical presentation and imaging features of different types and mimics of adrenal cortical hyperplasia.


Adrenal hyperplasia Adrenal thickening Adrenal imaging Cushing syndrome 



Supported by institutional CCSG (cancer center support grant) from the NIH/National Cancer Institute under Award Number P30CA016672.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Ajaykumar C. Morani
    • 1
  • Corey T. Jensen
    • 1
    Email author
  • Mouhammed Amir Habra
    • 2
  • Michelle M. Agrons
    • 3
  • Christine O. Menias
    • 4
  • Nicolaus A. Wagner-Bartak
    • 1
  • Akram M. Shaaban
    • 5
  • Alicia M. Roman-Colon
    • 3
    • 6
  • Khaled M. Elsayes
    • 1
  1. 1.Department of Diagnostic RadiologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of Endocrine Neoplasia and Hormonal DisordersThe University of Texas MD Anderson Cancer CenterHoustonUSA
  3. 3.Department of Diagnostic RadiologyBaylor College of MedicineHoustonUSA
  4. 4.Department of Diagnostic RadiologyMayo ClinicScottsdaleUSA
  5. 5.Department of Radiology and Imaging SciencesUniversity of UtahSalt Lake CityUSA
  6. 6.Department of RadiologyTexas Children’s HospitalHoustonUSA

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