Computed Tomography for Evaluation of Adrenal Dysfunction: A 10-Year Follow-Up

Abstract

Objective: To evaluate the computed tomography (CT) morphology of the adrenal glands of patients with adrenal dysfunction. Methods: CT examination of adrenal glands was performed in 331 consecutive patients with symptoms suggestive of adrenal dysfunction. CT was performed using 4-mm contiguous sections for the adrenal area. Intravenous contrast was injected in 78 cases of the adrenal mass lesions. Results: We analyzed 331 consecutive CT scans performed over a 10-year period. One hundred and twenty-seven patients had hypercortisolism, 23 had unilateral adrenal tumor, 18 had bilateral adrenal hyperplasia and 86 had normal adrenals. The CT diagnosis was confirmed at surgery in all 23 unilateral adrenal tumors except in 1 case (tuberculosis in a hyperplastic adrenal gland). Among the 91 cases of hypertension, 86 were being evaluated for pheochromocytoma and 5 for Conn’s syndrome. Forty-three had adrenal pheochromocytoma (1 bilateral) and 10 had extra-adrenal pheochromocytoma detectable on CT. Two of the 5 cases of hyperaldosteronism (Conn’s syndrome) had adrenal tumor. Adrenal enlargement was observed in 17 of the 33 cases of Addison’s disease. Four of them were cases of histoplasmosis. Conclusion: CT scanning is a sensitive tool for the imaging of adrenal glands. Both neoplastic and inflammatory lesions can alter adrenal gland morphology. Our results highlight the importance of studying adrenal morphology. CT morphology is helpful to decide the modality of treatment.