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Adrenocortical hyperplasia: a review of clinical presentation and imaging

Abdominal Radiology volume 45, pages 917–927 (2020)Cite this article

Abstract

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.

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Funding

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

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Authors and Affiliations

  1. Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1473, Houston, TX, 77030-4009, USA

    Ajaykumar C. Morani, Corey T. Jensen, Nicolaus A. Wagner-Bartak & Khaled M. Elsayes

  2. Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Mouhammed Amir Habra

  3. Department of Diagnostic Radiology, Baylor College of Medicine, Houston, TX, USA

    Michelle M. Agrons & Alicia M. Roman-Colon

  4. Department of Diagnostic Radiology, Mayo Clinic, Scottsdale, AZ, USA

    Christine O. Menias

  5. Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA

    Akram M. Shaaban

  6. Department of Radiology, Texas Children’s Hospital, Houston, TX, USA

    Alicia M. Roman-Colon

Authors
  1. Ajaykumar C. Morani
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  2. Corey T. Jensen
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  3. Mouhammed Amir Habra
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Correspondence to Corey T. Jensen.

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Morani, A.C., Jensen, C.T., Habra, M.A. et al. Adrenocortical hyperplasia: a review of clinical presentation and imaging. Abdom Radiol 45, 917–927 (2020). https://doi.org/10.1007/s00261-019-02048-6

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