HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) CME Test (opens in a new window) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Rockall, A. G. Articles by Reznek, R. H. Search for Related Content PubMed PubMed Citation Articles by Rockall, A. G. Articles by Reznek, R. H. Related Collections Computed Tomography Genitourinary Radiology Magnetic Resonance Imaging

CT and MR Imaging of the Adrenal Glands in ACTH-independent Cushing Syndrome¹

¹ From the Departments of Academic Radiology (A.G.R., S.A.B., S.A.A.S., R.H.R.), Endocrinology (A.M.I., J.P.M., A.B.G.), and Histopathology (S.D.C.), St Bartholomew's Hospital, Dominion House, St Bartholomew's Close, London EC1A 7ED, England. Presented as an education exhibit at the 2002 RSNA scientific assembly. Received April 2, 2003; revision requested May 7 and received June 12; accepted June 13. All authors have no financial relationships to disclose. Address correspondence to A.G.R. (e-mail: a.g.rockall@qmul.ac.uk).

Adrenocorticotropic hormone (ACTH)–independent hypercortisolism accounts for 15%–20% of cases of Cushing syndrome and always arises from primary adrenal disease. Computed tomographic (CT) and magnetic resonance (MR) imaging findings in 37 patients with primary adrenal Cushing syndrome were analyzed and correlated with pathologic findings. Hyperfunctioning adenomas (n = 24), together with functioning carcinomas (n = 10), accounted for 92% of cases. Adenomas had a significantly smaller mean size (3.5 vs 14.5 cm) and lower mean unenhanced CT attenuation value (11 vs 28 HU) than did carcinomas. The presence of necrosis, hemorrhage, and calcification favored a diagnosis of carcinoma. Six of 10 carcinoma patients had metastases at presentation. Two adenomas were seen within a myelolipoma, which was recognized at both CT and MR imaging due to its fat content, and two adenomas were of uncertain malignant potential. Bilateral disease—primary pigmented nodular adrenal dysplasia (PPNAD) (n = 2) and ACTH-independent macronodular adrenal hyperplasia (AIMAH) (n = 1)—had characteristic imaging features. In PPNAD, multiple tiny (2–5-mm) nodules were visible bilaterally, with no overall glandular enlargement and normal intervening adrenal tissue. In AIMAH, both glands were grossly enlarged and contained nodules up to 3 cm in diameter. Familiarity with the range of imaging appearances of the adrenal glands in primary adrenal Cushing syndrome may help establish the underlying diagnosis.

© RSNA, 2004

Index Terms: Adrenal gland, CT, 86.1211 • Adrenal gland, diseases, 86.54 • Adrenal gland, MR, 86.12141 • Adrenal gland, neoplasms, 86.31, 86.32 • Cushing syndrome, 86.541

This article has been cited by other articles:

				I. Ilias, A. Sahdev, R. H Reznek, A. B Grossman, and K. Pacak The optimal imaging of adrenal tumours: a comparison of different methods Endocr. Relat. Cancer, September 1, 2007; 14(3): 587 - 599. [Abstract] [Full Text] [PDF]

				T. D. Watson, S. J. Patel, and P. M. Nardi Case 121: Familial Adrenocorticotropin-independent Macronodular Adrenal Hyperplasia Causing Cushing Syndrome Radiology, September 1, 2007; 244(3): 923 - 926. [Full Text] [PDF]