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Adrenal imaging 

Adrenal imaging
Adrenal imaging

Peter Guest

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date: 28 June 2022

Evaluating the adrenal gland with imaging can be challenging. The adrenal glands may be morphologically within normal limits even in the presence of clear hyperfunction. Hyperplasia and small nodules may coexist. Nonfunctioning nodules are frequent and need to be differentiated from culpable hyperfunctioning adenomas or carcinomas. However, the increasingly sophisticated anatomical imaging provided by CT and MRI, together with the functional characterization afforded by radionuclide imaging, allows good correlation with clinical and endocrine parameters.

Embryologically, the adrenal cortex derives from coelomic mesoderm and the medulla from neural crest cells. Development is independent of the kidney and adrenal glands will normally be present in the absence of a kidney. In the newborn the adrenal glands are large structures, being one-third of the size of the kidneys. They involute rapidly, however, and in the adult are small structures. They are situated immediately above and anteromedial to the upper pole of the kidneys, although the left is less suprarenal. The right lies immediately behind the cava, alongside the right diaphragmatic crus. The left lies behind the splenic vein, lateral to the left crus.

The normal adrenal has a characteristic inverted Y- or V-shape with the two limbs fusing anteromedially. The most cranial section has a triangular appearance. Cross-sectional appearance varies according to the exact level. Each limb measures 2.5–4 cm in length and 3–6 mm in thickness. Greater than 1 cm thickness is definitely abnormal. Accessory adrenal tissue (rests) may be found in the kidney, testis, or ovary, and elsewhere in the retroperitoneum.

Arterial supply is from three sources: superior–multiple arteries from the inferior phrenic; middle from the aorta; and inferior from the renal artery. A single vein drains each adrenal. The left is a tributary of the left renal vein, the right leads directly to the cava, although rarely may join a hepatic vein first. The right adrenal vein is shorter and narrower.

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