Adrenal Masses

  • Julie H. Song
  • William W. Mayo-Smith
Part of the Medical Radiology book series (MEDRAD)


The adrenal gland is a common site of disease, involved in a spectrum of pathology. Multi-slice computed tomography (MSCT) is an essential tool in adrenal imaging due to its high accuracy in both the detection and characterization of adrenal masses. As a result, MSCT can make specific diagnoses, separating inconsequential adrenal masses from those that require intervention. This chapter discusses contemporary adrenal imaging by MSCT of commonly encountered adrenal masses in key clinical scenarios: detection of a biochemically active adrenal tumor, characterization of an adrenal mass in staging of patients with primary malignancy, and evaluation of an incidentally discovered adrenal mass.


Adrenal Gland Adrenal Mass Adrenocortical Carcinoma Adrenal Adenoma Cushing Syndrome 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Bae KT, Fuangtharnthip P, Prasad SR, Joe BN, Heiken JP (2003) Adrenal masses: CT characterization with histogram analysis method. Radiology 228:735–742PubMedCrossRefGoogle Scholar
  2. Baguet JP, Hammer L, Mazzuco TL, Chabre O, Mallion JM, Sturm N, Chaffanjon P (2004) Circumstances of discovery of phaeochromoytoma: a retrospective study of 41 consecutive patients. Eur J Endocrinol 150:681–686PubMedCrossRefGoogle Scholar
  3. Berland LL, Silverman SG, Gore RM et al (2010) Managing incidental findings on abdominal ct: white paper of the American College of Radiology incidental findings committee. J Am Coll Radiol 7:754–773PubMedCrossRefGoogle Scholar
  4. Bessell-Browne R, O’Malley ME (2007) CT of pheochromocytoma and paraganglioma: risk of adverse events with IV administration of nonionic contrast material. Am J Roentgenol 188:970–974CrossRefGoogle Scholar
  5. Blake MA, Kalra MK, Maher MM, Sahani DV, Sweeney AT, Mueller PR, Hahn PF, Boland GW (2004) Pheochromocytoma: an imaging chameleon. Radiographics 24:S87–S99PubMedCrossRefGoogle Scholar
  6. Blake MA, Kalra MK, Sweeney AT et al (2006) Distinguishing benign from malignant adrenal masses: multi-detector row CT protocol with 10-minute delay. Radiology 238:578–585PubMedCrossRefGoogle Scholar
  7. Boland GW, Lee MJ, Gazelle GS, Halpern EF, McNicholas MMJ, Mueller PR (1998) Characterization of adrenal masses using unenhanced CT: an analysis of the CT literature. Am J Roentgenol 171:201–204Google Scholar
  8. Boland GW, Blake MA, Hahn PF, Mayo-Smith WW (2008) Incidental adrenal lesions: principles, techniques, and algorithms for imaging characterization. Radiology 249:756–775PubMedCrossRefGoogle Scholar
  9. Bovio S, Cataldi A, Reimondo G et al (2006) Prevalence of adrenal incidentaloma in a contemporary computerized tomography series. J Endocrinol Invest 29:298–302PubMedGoogle Scholar
  10. Bowen AD, Keslar PJ, Newman B, Hashida Y (1990) Adrenal hemorrhage after liver transplantation. Radiology 176:85–88PubMedGoogle Scholar
  11. Burks DW, Mirvis SE, Shanmuganathan K (1992) Acute adrenal injury after blunt abdominal trauma: CT findings. Am J Roentgenol 158:503–507Google Scholar
  12. Caoili EM, Korobkin M, Francis IR, Cohan RH, Dunnick NR (2000) Delayed enhanced CT of lipid-poor adrenal adenomas. Am J Roentgenol 175:1411–1415Google Scholar
  13. Caoili EM, Korobkin M, Francis IR, Cohan RH, Platt JF, Dunnick NR, Raghupathi KI (2002) Adrenal masses: characterization with combined unenhanced and delayed enhanced CT. Radiology 222:629–633PubMedCrossRefGoogle Scholar
  14. Cheema P, Cartegena R, Staubitz W (1981) Adrenal cyst: diagnosis and treatment. J Urol 126:396–399PubMedGoogle Scholar
  15. Dunnick NR, Korobkin M (2002) Imaging of adrenal incidentalomas: current status. Am J Roentgenol 179:559–568Google Scholar
  16. Dunnick NR, Heaston D, Halvorsen R, Moore AV, Korobkin M (1982) CT appearance of adrenal cortical carcinoma. J Comput Assist Tomogr 6:978–982PubMedCrossRefGoogle Scholar
  17. Dunnick NR, Leight GS Jr, Roubidoux MA, Leder RA, Paulson E, Kurylo L (1993) CT in the diagnosis of primary aldosteronism: sensitivity in 29 patients. Am J Roentgenol 160:321–324Google Scholar
  18. Fishman EK, Deutch BM, Hartman DS, Goldman SM, Zerhouni EA, Siegelman SS (1987) Primary adrenocortical carcinoma: CT evaluation with clinical correlation. Am J Roentgenol 148:531–535Google Scholar
  19. Francis IR, Casalino DD, Arellano RS, et al (2009) Incidentally discovered adrenal mass. American College of Radiology, ACR appropriateness criteria.
  20. Grumbach MM, Biller BMK, Braunstein GD et al (2003) Management of the clinically inapparent adrenal mass (“incidentaloma”). Ann Intern Med 138:424–429PubMedGoogle Scholar
  21. Herrera MF, Grant CS, van Heerden JA, Sheedy PF II, Ilstrup DM (1991) Incidentally discovered adrenal tumors: an institutional perspective. Surgery 110:1014–1021PubMedGoogle Scholar
  22. Jhaveri KS, Wong F, Ghai S, Haider MA (2006) Comparison of CT histogram analysis and chemical shift MRI in the characterization of indeterminate adrenal nodules. Am J Roentgenol 187:1303–1308CrossRefGoogle Scholar
  23. Kenney PJ, Robbins GL, Ellis DA, Spirt BA (1985) Adrenal glands in patients with congenital renal anomalies: CT appearance. Radiology 155:181–182PubMedGoogle Scholar
  24. Kenney PJ, Wagner BJ, Rao P, Heffess CS (1998) Myelolipoma: CT and pathologic features. Radiology 208:87–95PubMedGoogle Scholar
  25. Kloos RT, Gross MD, Francis IR, Korobkin M, Shapiro B (1995) Incidentally discovered adrenal masses. Endocr Rev 16:460–484PubMedGoogle Scholar
  26. Korobkin M, Giordano TJ, Brodeur FJ et al (1996a) Adrenal adenomas: relationship between histologic lipid and CT and MR findings. Radiology 200:743–747PubMedGoogle Scholar
  27. Korobkin M, Brodeur FJ, Yutzy GG, Francis IR, Quint LE, Dunnick NR, Kazerooni EA (1996b) Differentiation of adrenal adenomas from nonadenomas using CT attenuation values. Am J Roentgenol 166:531–536Google Scholar
  28. Korobkin M, Brodeur FJ, Francis IR, Quint LE, Dunnick NR, Londy F (1998) CT time-attenuation washout curves of adrenal adenomas and nonadenomas. Am J Roentgenol 170:747–752Google Scholar
  29. Lam KY, Lo CY (2001) Adrenal lipomatous tumours: a 30 year clinicopathological experience at a single institution. J Clin Pathol 54:707–712PubMedCrossRefGoogle Scholar
  30. Lee MJ, Hahn PF, Papanicolaou N, Egglin TK, Saini S, Mueller PR, Simeone JF (1991) Benign and malignant adrenal masses: CT distinction with attenuation coefficients, size, and observer analysis. Radiology 179:415–418PubMedGoogle Scholar
  31. Lee JE, Evans DB, Hickey RC, Sherman SI, Gagel RF, Abbruzzese MC, Abbruzzese JL (1998) Unknown primary cancer presenting as an adrenal mass: frequency and implications for diagnostic evaluation of adrenal incidentalomas. Surgery 124:1115–1122PubMedCrossRefGoogle Scholar
  32. Mansmann G, Lau J, Balk E, Rothberg M, Miyachi Y, Bornstein SR (2004) The clinically inapparent adrenal mass: update in diagnosis and management. Endocr Rev 25:309–340PubMedCrossRefGoogle Scholar
  33. Mayo-Smith WW, Boland GW, Noto RB, Lee MJ (2001) State-of-the-art adrenal imaging. RadioGraphics 21:995–1012PubMedGoogle Scholar
  34. Mitchell DG, Crovello M, Matteucci T, Petersen RO, Miettinen MM (1992) Benign adrenocortical masses: diagnosis with chemical shift MR imaging. Radiology 185:345–351PubMedGoogle Scholar
  35. Motta-Ramirez GA, Remer EM, Herts BR, Gill IS, Hamrahian AH (2005) Comparison of CT findings in symptomatic and incidentally discovered pheochromocytomas. Am J Roentgenol 185:684–688Google Scholar
  36. Mukherjee JJ, Peppercorn PD, Reznek RH, Patel V, Kaltsas G, Besser M, Grossman AB (1997) Pheochromocytoma: effect of nonionic contrast medium in CT on circulating catecholamine levels. Radiology 202:227–231PubMedGoogle Scholar
  37. NIH (2002) NIH state-of-the-science statement on management of the clinically inapparent adrenal mass (“incidentaloma”). NIH Consens State Sci Statements 19:1–25Google Scholar
  38. Olsson CA, Krane RJ, Klugo RC, Selikowitz SM (1973) Adrenal myelolipoma. Surgery 73:665–670PubMedGoogle Scholar
  39. Outwater EK, Siegelman ES, Radecki PD, Piccoli CW, Mitchell DG (1995) Distinction between benign and malignant adrenal masses: value of T1-weighted chemical-shift MR imaging. Am J Roentgenol 165:579–583Google Scholar
  40. Paling MR, Williamson BRJ (1983) Adrenal involvement in non-Hodgkin lymphoma. Am J Roentgenol 141:303–305Google Scholar
  41. Patel SM, Lingam RK, Beaconsfield TI, Tran TL, Brown B (2007) Role of radiology in the management of primary aldosteronism. RadioGraphics 27:1145–1157PubMedCrossRefGoogle Scholar
  42. Paulsen SD, Nghiem HV, Korobkin M, Caoili EM, Higgins EJ (2004) Changing role of imaging-guided percutaneous biopsy of adrenal masses: evaluation of 50 adrenal biopsies. Am J Roentgenol 182:1033–1037Google Scholar
  43. Peña CS, Boland GW, Hahn PF, Lee MJ, Mueller PR (2000) Characterization of indeterminate (lipid-poor) adrenal masses: use of washout characteristics at contrast-enhanced CT. Radiology 217:798–802PubMedGoogle Scholar
  44. Rana AI, Kenney PJ, Lockhart ME, McGwin G Jr, Morgan DE, Windham ST III, Smith JK (2004) Adrenal gland hematomas in trauma patients. Radiology 230:669–675PubMedCrossRefGoogle Scholar
  45. Remer EM, Motta-Ramirez GA, Shepardson LB, Hamrahian AH, Herts BR (2006) CT histogram analysis in pathologically proven adrenal masses. Am J Roentgenol 187:191–196CrossRefGoogle Scholar
  46. Rockall AG, Babar SA, Sohaib SA, Isidori AM, Diaz-Cano S, Monson JP, Grossman AB, Reznek RH (2004) CT and MR imaging of the adrenal glands in ACTH-independent Cushing Syndrome. RadioGraphics 24:435–452PubMedCrossRefGoogle Scholar
  47. Rozenblit A, Morehouse HT, Amis ES (1996) Cystic adrenal lesions: CT features. Radiology 201:541–548PubMedGoogle Scholar
  48. Sasiwimonphan K, Takahashi N, Leibovich BC, Kawashima A (2010) Adrenal hematoma after nephrectomy. Am J Roentgenol 195:1334–1337CrossRefGoogle Scholar
  49. Sevitt S (1955) Post-traumatic adrenal apoplexy. J Clin Pathol 8:185–194PubMedCrossRefGoogle Scholar
  50. Silverman SG, Mueller PR, Pinkney LP, Koenker RM, Seltzer SE (1993) Predictive value of image-guided adrenal biopsy: analysis of results of 101 biopsies. Radiology 187:715–718PubMedGoogle Scholar
  51. Sohaib SA, Hanson JA, Newell-Price JDC, Trainer PJ, Monson JP, Grossman AB, Besser GM, Reznek RH (1999) CT appearance of the adrenal glands in adrenocorticotrophic hormone-dependent Cushing’s syndrome. Am J Roentgenol 172:997–1002Google Scholar
  52. Solomon N, Sumkin J (1988) Right adrenal gland hemorrhage as a complication of liver transplantation: CT appearance. J Comput Assist Tomogr 12:95–97PubMedCrossRefGoogle Scholar
  53. 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. Am J Roentgenol 190:1163–1168CrossRefGoogle Scholar
  54. Szolar DH, Kammerhuber FH (1998) Adrenal adenomas and nonadenomas: assessment of washout at delayed contrast-enhanced CT. Radiology 207:369–375PubMedGoogle Scholar
  55. Welch TJ, Sheedy PF II, Stephens DH, Johnson CM, Swensen SJ (1994) Percutaneous adrenal biopsy: review of a 10-year experience. Radiology 193:341–344PubMedGoogle Scholar
  56. Young WF Jr (2007) The incidentally discovered adrenal mass. N Engl J Med 356:601–610PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg  2011

Authors and Affiliations

  1. 1.Department of Diagnostic ImagingRhode Island Hospital-Warren Alpert Medical School of Brown UniversityProvidenceUSA

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