Total Adrenal Volume Research Articles

Diagnostic and Prognostic Value of Quantitative Computed Tomography Parameters of Adrenal Glands in Patients from Internistled ICU with Sepsis and Septic Shock

The aim was to prospectively evaluate the diagnostic and prognostic value of different quantitative analysis methods assessing adrenal gland parameters on contrast-enhanced CT scans in patients with septic conditions. Seventy–six patients (49 men, 27 women) received CT scans for focus search. Adrenal glands were analyzed by means of three different methods: subjective region of interest (ROI) measurement, organ segmentation and histogram analysis using semi-automated software. Univariate analyses with multiple testing thresholds and receiver operating characteristic curves were performed. Clinical endpoints were 8-days, 28-days and 6-months mortality. Forty-four CT scans were analyzed (ground truth: patients with no sepsis: n = 6; patients with sepsis: n = 15; patients in septic shock: n = 21). Left adrenal gland (LAG) values were analyzed and compared, as data variation was lower than in the right adrenal glands. In patients with septic conditions, the combination of high LAG and Inferior Vena Cava (IVC) density values was highly specific for septic shock with all three methods. Only segmentation values were significantly different between the sepsis and septic shock groups after confounder correction (p = 0.048). Total adrenal gland volume was 20% higher in the septic shock patients while a relatively small LAG volume within the septic shock subgroup was associated with higher mortality at day 8 (AUC = 0.8; p = 0.006) and at 6 months (AUC = 0.7; p = 0.035). However, time-consuming density analysis methods assessing adrenal glands do not provide additional diagnostic value in patients with septic conditions. The combination of high LAG and IVC attenuation values seems to be highly specific for septic shock, regardless of the analysis type. Adrenal gland volume reveals short- and long-term prognostic capacity.

Sonographic Evaluation of Fetal Adrenal Gland in Gestational Diabetes: Relation to Fetal Growth and Maternal Biochemical Markers.

To relate measurements and volume of the fetal adrenal gland in third trimester ultrasound in diabetic pregnancies (1) to birth weight; (2) to other sonographic markers of diabetic fetopathy (expected fetal weight, sectional area, and fractional volume in fetal limbs); and (3) to maternal biochemical markers of diabetes (HbA1c, leptin). Fetal adrenal gland measurements were obtained between 32 and 34 weeks. The gland length, width, depth, and volume (by Virtual Organ Computer-Aided Analysis [VOCAL]) were measured for total gland and fetal zone. Fetal total and fat sectional area and fractional volume were obtained in arm and thigh. A maternal blood sample was obtained. Univariate and multivariate models were used to assess the associations. Thirty-nine diabetic pregnancies were included. Birth weight related significantly to total and fetal zone adrenal depth, and total adrenal volume in third trimester. Total adrenal length and corrected adrenal gland volume also showed a significant correlation to birth weight percentile in univariate and multivariate models. Total adrenal volume associated significantly to total and fat areas and volumes in fetal limbs. Both maternal leptin and HbA1c levels found a significant positive relation to fetal total adrenal volume and corrected adrenal gland volume. Total adrenal gland volume showed a significant association to maternal HbA1c level in multivariate model. An enlargement of the fetal adrenal gland may be observed in gestational diabetes, not only related to birth weight, but also to distinctive features of diabetic pregnancies, such as fat tissue fetal deposits or maternal biochemical markers.

The Adrenal Gland Volume Measurements in Manifestation of the Metabolic Status in Type-2 Diabetes Mellitus Patients.

Objectives. The aim of our study was to investigate the differences in adrenal gland volume between nondiabetic controls and Type-2 diabetic patients and to examine the influence of glycemic control in diabetes mellitus on adrenal gland volume. Methods. From March 2 to November 25, 2015, 62 consecutive patients with Type-2 DM along with 62 nondiabetics matched by age, gender, and BMI were enrolled in this prospective study. Our diabetes patients were categorized into two groups, well-controlled and poorly controlled diabetes groups. Adrenal volumetric measurements were performed by two radiologists, prospectively and independently, with semiautomatic software. Interobserver reliability was studied using the interobserver correlation coefficient (ICC). Results. The total adrenal volume (TAV) was significantly higher in Type-2 diabetic patients when compared with nondiabetic patients (p < 0.05). When we investigated diabetic patients according to glycemic controls, the TAVs in controlled diabetic patients were significantly higher than in those of the poorly controlled or uncontrolled diabetic patients (p < 0.05). Nondiabetic control patients have significantly smaller TAVs when compared to controlled and poorly or noncontrolled diabetic patients (p < 0.05). Conclusion. Our study suggests that adrenal gland volume measurement may be used as an indirect marker of glycemic control in patients with diabetes.

MDCT Linear and Volumetric Analysis of Adrenal Glands: Normative Data and Multiparametric Assessment.

To study linear and volumetric adrenal measurements, their reproducibility, and correlations between total adrenal volume (TAV) and adrenal micronodularity, age, gender, body mass index (BMI), visceral (VAAT) and subcutaneous adipose tissue volume (SAAT), presence of diabetes, chronic alcoholic abuse and chronic inflammatory disease (CID). We included 154 patients (M/F, 65/89; mean age, 57years) undergoing abdominal multidetector row computed tomography (MDCT). Two radiologists prospectively independently performed adrenal linear and volumetric measurements with semi-automatic software. Inter-observer reliability was studied using inter-observer correlation coefficient (ICC). Relationships between TAV and associated factors were studied using bivariate and multivariable analysis. Mean TAV was 8.4 ± 2.7cm(3) (3.3-18.7cm(3)). ICC was excellent for TAV (0.97; 95% CI: 0.96-0.98) and moderate to good for linear measurements. TAV was significantly greater in men (p < 0.0001), alcoholics (p = 0.04), diabetics (p = 0.0003) and those with micronodular glands (p = 0.001). TAV was lower in CID patients (p = 0.0001). TAV correlated positively with VAAT (r = 0.53, p < 0.0001), BMI (r = 0.42, p < 0.0001), SAAT (r = 0.29, p = 0.0003) and age (r = 0.23, p = 0.005). Multivariable analysis revealed gender, micronodularity, diabetes, age and BMI as independent factors influencing TAV. Adrenal gland MDCT-based volumetric measurements are more reproducible than linear measurements. Gender, micronodularity, age, BMI and diabetes independently influence TAV. • Volumetric measurements are more reproducible than linear measurements for adrenal glands. • Inter-observer reproducibility of adrenal gland volume is excellent using semiautomatic software. • Gender, age, BMI, and diabetes independently influence total adrenal gland volume. • Adrenal micronodularity is associated with increased total adrenal gland volume.

Linear and Volumetric Evaluation of the Adrenal Gland—MDCT-Based Measurements of the Adrenals

The purpose of this study was to provide normal values of volumetry and linear dimensions of adrenal glands. Contrast-enhanced multidetector computed tomography scans of 105 patients were evaluated in this retrospective study. Imaging software was used both to measure the adrenal gland volume and to determine linear dimensions and density. For interobserver reliability, determination was repeated by a second reader in 10 patients selected at random. The mean adrenal volume was 4.84 (±1.67) cm³ on the left side and 3.62 (±1.23) cm³ on the right side. The total adrenal volume was mainly influenced by body weight (P < .001) and gender with women having smaller glands on average. The total width of the adrenal gland was 15.80 (±3.05) mm on the right side and 18.96 (±3.37) mm on the left side. There was a significant correlation between volume and linear measurements (P < .001). The mean density of both adrenal glands was 32.66 (±19.64) HU. Overall, interobserver reliability was high for volumetry (left adrenal, r = 0.98; right adrenal, r = 0.90) and low for linear dimensions. Normal data for volumetry and linear dimensions are provided. There is a concordance between volumetric and linear assessment. However, volumetry is more reproducible.

Evaluation of Normal Adrenal Gland Volume by 64-slice CT

Objective To measure volume and other parameters of normal adrenal glands in Chinese adults with 64-slice multidetector CT, to evaluate the relationship of volume result with age, sex and body size, and to explore the correlations between adrenal volume and other measurements. Methods This study was based on 125 acquired contrast-enhanced upper abdominal CT scans performed with a 64-slice CT. The final study group consisted of 81 patients (49 males, 32 females). Portal venous phase images were studied for the measurements. Both the reconstruction interval and thickness were 1.5 mm. Each adrenal gland was outlined manually with computer-assistant technology to calculate its volume. The maximal sectional area, length, width and thickness of each adrenal gland were also measured. Results The mean age of total population was 47.9±13.0 (range: 20-76) years. The left, right, and total adrenal gland volumes were 4.23±0.74 (range: 2.85-5.83) cm3, 4.26±0.86 (2.59-6.56) cm3, and 8.50±1.40 (5.80-11.39) cm3, respectively. These volumes increased with weight (r=0.381, 0.389, and 0.437 respectively, all P<0.001), height (r=0.386, P<0.001; r=0.297, P=0.007; r=0.384, P<0.001) and body surface area (r=0.406, 0.392, and 0.452, all P<0.001). There was no significant difference in left, right or total adrenal volume with regard to sex after applying General Linear Model procedure to reduce the impact of weight (F=1.304, 0.064, and 0.597, all P>0.05), nor did volume change significantly with age (r=-0.033, -0.014, and -0.026, all P>0.05). Nearly all descriptors of bilateral adrenal glands correlated with ipsilateral volume except thickness (r=-0.027, P=0.814) and width (r=0.166, P=0.138) in the left side. Among these parameters, length had a stronger correlation with volume than others in the both left (r=0.412, P<0.001) and right (r=0.516, P<0.001) adrenal glands. Conclusion Our study has defined the volume distribution and other parameters of normal adrenal glands in Chinese adults, which provide a baseline for future studies.

Total Adrenal Volume But Not Testicular Adrenal Rest Tumor Volume Is Associated with Hormonal Control in Patients with 21-Hydroxylase Deficiency

Patients with 21-hydroxylase deficiency (21-OHD) have been shown to develop adrenal adenomas and, in males, testicular adrenal rest tumors (TARTs) at a high percentage. The aim of this study was to evaluate the interrelation of adrenal masses and TARTs as well as factors stimulating tumor growth of orthotopic and ectopic adrenal tissue in 21-OHD. In a cross-sectional study, 26 adult male patients with classic 21-OHD (15 salt wasting, 11 simple virilizing; age range, 18-48 yr) were clinically assessed according to their hormonal control. Magnetic resonance imaging of the adrenals (26 of 26) and of the testes (18 of 26) was performed. Adrenal size and morphology was compared to 26 age-matched controls. Combined adrenal volume of 21-OHD patients was significantly higher (median, 9.3 ml; range, 3.2-124.5 ml) in comparison to controls (median, 7.4 ml; range, 5.5-10.8 ml; P = 0.005). Morphologically, adrenals were classified as normal without nodules in 27% of 21-OHD patients compared to 69% of controls. None of the controls, but 42% of 21-OHD patients had an overall adrenal volume higher than 11 ml. Ten of 18 patients had TARTs with a median volume of 3.3 ml (range, 0.4-21.6 ml). Total adrenal volume and tumor size but not TART volume correlated positively with current parameters of hormonal control (androstenedione, morning 17-OHP in serum, pregnanetriol in 24-h urine; P < 0.001 for each). Baseline ACTH was independent of adrenal and TART volume. There was no correlation of total adrenal or adrenal tumor size with TART volume. These data provide indirect evidence that different factors regulate the growth of orthotopic adrenal tissue and ectopic adrenal remnants in TARTs.

The potential role of increased adrenal volume in the pathophysiology of obesity-related Type 2 diabetes

The hypothalamic-pituitary-adrenal (HPA) axis seems to play an important role in obesity and Type 2 diabetes (DM). The aim of the present study was to determine the adrenal volume in obese patients with DM in comparison to obese non-diabetic patients. Eleven diabetic obese and 19 non-diabetic obese women were sequentially invited to take part in the study. Computed tomography (CT) scan of the abdomen was performed to determine adrenal volume, visceral (VF) and sc fat (SCF). Daily urinary free cortisol (UFC) was used as a measure of integrated cortisol production. In the diabetic patients, hemoglobin A1c was measured as an index of metabolic control. Compared to nondiabetic controls, patients with diabetes had a significantly higher total adrenal volume (4.29+/-1.50 vs 2.95+/-1.64; p=0.03). A highly significant correlation was detected between VF and VF/SCF ratio and total adrenal volume in the whole group (r=0.36, p=0.04 and r=0.48, p=0.008, respectively). This study, therefore, suggests an association between abdominal obesity, enlarged adrenals and Type 2 diabetes. These findings support the hypothesis that an increased activity of the HPA axis in obese subjects may be involved in the pathogenesis of Type 2 diabetes.

Postnatal involution of the human adrenal fetal zone: Stereologic description and apoptosis

During the first weeks of postnatal development the fetal zone (FZ) of the human adrenal cortex rapidly disappears. Present studies aimed to describe cellular aspects of this involution and to correlate them with apoptosis. Adrenals of 38 newborns and infants (aged 1–240 days) were obtained from autopsies due to accidental death. Postnatal decrease in the adrenal gland weight may be divided into 2 distinct phases: rapid one lasting from the birth till the end of the second week of life, and followed by a slower one. This decrease is highly correlated with the decrease of both: the volume of FZ and quantity of its cells. During the whole investigated period, volume of the FZ decreases from 8,017 to 248 mm3 (from 70 to 3% of total adrenal volume) and the quantity of its parenchymal cells from 3×109 to 0.15×109 (from 40 to 5% of all parenchymal cells). The average volume of the FZ cell decreases from 2,200 to 1,400 μm3. The volume of FZ stroma (connective tissue and blood vessels) expands notably during the first day and decreases from day 5th of life. The apoptotic index of the FZ parenchymal cells is the highest during the second week of life (ca 30%), and subsequently declines (ca 20%). Thus, the rapid involution of the FZ is connected with marked hemorrhagic changes and increased apoptotic index of parenchymal cells, while during the slow phase (after 2nd week on) apoptotic index is lower and rather constant.

Weight and shape of the human adrenal medulla in various age groups.

The weight and shape of the adrenal medulla were studied in 118 adrenal glands obtained at autopsies of 62 patients (38 males and 24 females) between 0 and 52 years of age. In adolescents 15 years and older and adults cases of sudden death only were entered in this study. The weight was calculated using morphometric measurements done on serial sections of the glands. In the new-born, the medulla accounts for less than 1% of the total volume of the adrenal gland. Though there is a rapid growth of the adrenal medulla after birth, the percentage of adrenal medullary volume at all age levels during childhood and adolescence is lower than in adults where it constitutes 9% of the total adrenal volume on the average. This corresponds to an average medullary weight of 0.43 g. In the new-born, the medulla consists of a thin plate made up of immature medulloblasts. Within a few months these are transformed into mature medullary cells; the shape of the medulla soon approaches that of the adult gland: an increase in thickness around the central vein and flat processes into the alae. With increasing age the cortico-medullary border becomes irregular and ragged. Especially in the vicinity of the central vein an intermingling of medullary and cortical cell complexes is found. An unequivocal diagnosis of genuine adrenal medullary hyperplasia can be established only by weighing the dissected medulla or by applying morphometric methods.

Pineal-adrenal relationship in a lizard Calotes versicolor

Pinealectomy caused hypertrophy and melatonin atrophy of the adrenal cortex as reflected by alterations in the percentage of total adrenal volume and weight of the adrenal in the lizard, Calotes versicolor.