Glandele suprarenale

■ Suprarenal glands viewed from behind

■ Suprarenal glands viewed from the front.
Aspect normal

1 Portal vein
2 Colon
3 Stomach
4 Pancreas
5 Splenic vein
6 Spleen
7 Left Adrenal gland
8 Left Kidney
9 Aorta
10 Inferior Vena Cava
11 Right Kidney
12Right Adrenal Gland
13 Liver
 Normal adrenal glands (arrows), as seen on
■ Cushing's syndrome caused by a hyperfunctioning adenoma.
The contrast-enhanced CT scan shows a 3-cm adenoma
(arrows) in the left adrenal gland.
 Bilateral adrenal hyperplasia (arrowed) in a patient
with Cushing's disease
■ CT scan of the abdomen performed 4 yr before
the onset of symptoms, showing a small nodular
lesion near the left renal hilum (arrow).
■ Recent CT (A) and MRI (B) of the abdomen showing
growth in the lesion seen in Fig. 1 (arrow). The nodule
was approximately 3.5 cm in diameter.
■ Gross appearance of ectopic adrenocortical
adenoma. Typical of black adenoma associated
with Cushing’s syndrome, the cut surface is
darkly pigmented
 A functioning cortical adenoma resulting in precocious puberty in a 5-year-old
boy:
contrast-enhanced CT scan showing an enhancing adrenal mass (arrows).

A functioning cortical adenoma resulting in precocious puberty in a 5-year-old boy:

contrast-enhanced CT scan showing an enhancing adrenal mass (arrows).
■ Picture 4. Contrast-enhanced axial CT scan. A left
adrenal adenoma expands the tips of the gland
limbs.
■ Contrast-enhanced axial CT scan. A right adrenal
adenoma has enlarged the gland, giving it a
bulbous appearance.
 6 months earlier.
Excretory urogram shows inferior displacement of the right kidney.
Longitudinal US scan of the right kidney shows a complex,
echogenic suprarenal mass.
Nonenhanced CT scan shows a right suprarenal mass
containing a rounded area of increased attenuation Proved hemorrhagic
(curved arrow). pseudocyst in
The intracystic clot mimics a mural nodule in a cystica 21-year-old
tumor. woman who
experienced
A fluid-fluid level in the mass (straight arrow) is indicative blunt trauma
of hemorrhage in the
lesion. 6 months earlier.
Excretory urogram shows inferior
displacement of the right kidney.
Longitudinal US scan of the right
kidney shows a complex,
echogenic suprarenal mass.
Nonenhanced CT scan shows a
right suprarenal mass
containing a rounded area of
increased attenuation (curved
arrow).
The intracystic clot mimics a
mural nodule in a cystic tumor.
A fluid-fluid level in the mass
(straight arrow) is indicative of
hemorrhage in the lesion.
Proved cavernous hemangioma in a 69-year-old man.
Enhanced helical CT scan obtained during the corticomedullary junction
phase shows a left adrenal mass with peripheral nodular enhancement

Proved cavernous hemangioma in a 69-year-old man.

Enhanced helical CT scan obtained during the corticomedullary junction
phase shows a left adrenal mass with peripheral nodular enhancement
 Adrenal cortical
adenoma with very
atypical imaging
features
■ Noncontrast CT scan shows a
large 11-cm heterogeneous mass
with amorphous calcification and
macroscopic fat (arrows) in the
expected location of the left
suprarenal gland. (B) Sagittal
reconstruction images show a
large heterogeneous mass at the
upper pole that is inferiorly
displacing the left kidney with a
perceptible plane of cleavage
between the mass and the left
■  Proved adrenal adenoma with intratumoral hemorrhage
in a 48-year-old woman. CT scan obtained after
excretory urography shows a large cystic mass with a
fluid-fluid level within it. Note the flecks of calcification
in the wall (arrow).
■ 49-year-old woman with low-density
pheochromocytoma who has
neurofibromatosis 1. CT scan shows rounded
low-density right adrenal mass (arrow) with
attenuation value of 9 H.
■ 57-year-old man with medullary hyperplasia
producing pheochromocytoma syndrome. CT scan
shows 0.8-cm left adrenal nodule (arrow) with 1.8-H
attenuation
■   Pheochromocytoma. Abdominal CT scan demonstrating left suprarenal mass
of soft tissue attenuation representing a paraganglioma.
■  Proved pheochromocytoma in a 37-year-old
man with von Hippel-Lindau disease. Enhanced
CT scan shows a right adrenal mass. Note the
area of low attenuation (arrow).
 A 37-year-old patient was referred to our hospital for probable
pheochromocytoma of the urinary bladder.
The patient had high blood pressure (BP)
levels that increased after each micturition.
The patient reported severe postmicturition headaches
, palpitations, tinnitus, visual flashes,
and symptoms of angina pectoris during the past 4 years.

■ Pelvic, contrast-enhanced, axial CT scan

showing a right retrovesical mass lesion
A 37-year-old patient was referred to our hospital for probable
pheochromocytoma of the urinary bladder.
The patient had high blood pressure (BP)
levels that increased after each micturition.
The patient reported severe postmicturition headaches
, palpitations, tinnitus, visual flashes,
and symptoms of angina pectoris during the past 4 years.
 e
n
s
CT scan of abdomen showing enlargement of both adrenal glands h
o
w
■ CT scan of i
n
abdomen showing
g
e
enlargement of bo
n
adrenal glands.
l
a
r
g
e
m
e
n
t
o
Lymphomas commonly metastasize to the adrenal f
glands, b
1 but they seldom cause adrenal insufficiency o
t
■ Axial CT scan obtained without intravenous contrast
enhancement. This image shows bilateral adrenal
calcification, and the findings confirm the absence of a
mass. Patients with this type of adrenal calcification do not
necessarily have adrenal insufficiency.
 We describe a case of Addison's disease caused by bilateral suprarenal haemorrhage in a
patient heterozygous for factor V Leiden defect.This is the first reported caseb of isolated
bilateral suprarenal haemorrhage in a patient with this disorder. Because of the unique
blood supply of the suprarenal glands, we believe that suprarenal haemorrhage was
secondary to venous infarction causedby venous thrombosis in suprarenal veins and
venous plexus. ■ bilateral suprarenal
masses
■ suggesting bilateral
haemorrhage into
suprarenal glands.

We describe a case of Addison's disease caused by bilateral suprarenal haemorrhage in a patient

heterozygous for factor V Leiden defect.This is the first reported caseb of isolated bilateral
suprarenal haemorrhage in a patient with this disorder. Because of the unique blood supply of the
suprarenal glands, we believe that suprarenal haemorrhage was secondary to venous infarction
causedby venous thrombosis in suprarenal veins and venous plexus.
■  Adrenal hematoma in a 44-year-old man receiving
coumarin for pulmonary emboli from deep venous
thrombosis. Nonenhanced helical CT scan shows a large,
hyperattenuating left adrenal mass, a finding consistent
with acute hemorrhage
■ Typical enhanced computed tomography scan
appearance of acute adrenal hemorrhage
■ Unenhanced CT in an asymptomatic man reveals
a 6-cm right adrenal mass with density
measurements that range from -14 to -27
Hounsfield units, consistent with myelolipoma
■ . Contrast-enhanced CT reveals a left adrenal mass with a
large deposit of macroscopic fat, measuring -97 Hounsfield
units, diagnostic of adrenal myelolipoma
■ Picture 4. Contrast-enhanced CT in a 63-year-old man
reveals several scattered foci of macroscopic fat in the
left adrenal mass, confirming a diagnosis of myelolipoma.
■  Nontraumatic bleeding from a myelolipoma in a 65-year-old
man. Enhanced CT scan shows a large mass (M) that contains
areas of fat. Acute hemorrhage is present in and around the mass
adrenocortical carcinomaadrenocortical carcinoma

■ CT demonstrates a large heterogeneous mass

with flocculent calcifications and central
necrosis
■ Contrast-enhanced CT scan depicts
heterogeneously enhancing and partially necrotic
bilateral adrenal metastases from lung carcinoma.
■  Hemorrhagic adrenal metastasis in a 60-year-old woman with acute onset of right flank
pain and hemoptysis.Nonenhanced helical CT scan through the right suprarenal region
shows a large mass of mixed increased and decreased attenuation with high-attenuation
stranding around the mass, findings consistent with hemorrhage. Sagittally reformatted
image generated from enhanced helical CT data shows the relationship of the right
adrenal mass (M) to the right kidney and liver. Note the extension of the hemorrhage to
the perinephric space around the upper pole of the right kidney. Chest radiographs and
CT scans (not shown) revealed a lobulated mass in the right upper lobe of the lung.
Percutaneous needle biopsy of the right adrenal mass yielded undifferentiated
adenocarcinoma.