Related Subjects:
|Adrenal Physiology
|Addisons Disease
|Phaeochromocytoma
|Adrenal Adenomas
|Adrenal Cancer
|Cushing Syndrome
|Cushing Disease
|Congenital Adrenal hyperplasia
|Primary hyperaldosteronism (Conn's syndrome)
|ACTH
|McCune Albright syndrome
About
- Seen in 1-5% CT and MRI imaging
Associations of Adrenal Masses
- MEN 1 and 2, Carney syndrome
- McCune-Albright syndrome
Aetiology
- TB or fungal infection
- Malignancy
- Abscess
- Others
Clinical
- Abdominal/flank pain and fullness
- Glucocorticoid excess: weight gain, central obesity, moon facies, purple
striae, proximal muscle weakness, osteoporosis, menstrual irregularities,
hypogonadism, hypertension, diabetes mellitus
- Mineralocorticoid excess: hypokalemia (spontaneous or easily provoked),
muscle cramps, muscle weakness, nocturia, polyuria, hypertension,
oedema
- Androgen excess: hirsutism, menstrual irregularities, infertility,
acne, male pattern balding, breast atrophy
- Catecholamine excess: hypertension, paroxysms, headache, tachycardia,
increased sweating, orthostatic hypotension, constipation,
abdominal/chest pain
Investigations
- Check U&E for hypokalaemia, Cortisol, Urinary catecholamines
- Renin/Aldosterone, 18-OH corticosterone
- Androgen excess: Serum testosterone, DHEA-S, androstenedione, prolactin, LH,
FSH
- Adrenocortical carcinoma: 24-h urine 17-keto-steroids (17-KS), 24-h
UFC
- CT or MRI abdomen: adrenal adenomas, phaeochromocytomas hypointense relative to liver on T2-weighted image; adrenal carcinomas hyperintense on
T2 image. if <4 cm and 24-h urine 17-KS normal, not primary adrenocortical carcinoma
Management
- Search for indication of primary malignancy and assess size of adrenal tumour
- Assessment of radiological features; irregular contour, inhomogeneity
or necrosis, calcification, unenhanced CT with high attenuation
value (>10 HU), local invasion raise suspicion for adrenocortical carcinoma
- Biochemical endocrine evaluation
- Consider Surgery if
- Phaeochromocytoma
- Unilateral functional adrenocortical adenoma
- Tumour >4 cm
- Enlarging tumour , suspicious radiological features
- Elevated urinary 17-KS
- Not indicated for hyperaldosteronism from bilateral hyperplasia
- Adrenocortical carcinoma: poor long-term prognosis; micrometastases
common at diagnosis; median survival with surgery, 14–36 mo
References