Preliminary Diagnosis: Adrenal Hyperplasia
I. What imaging technique is first-line for this diagnosis?
CT scanning without intravenous contrast and without oral contrast
II. Describe the advantages and disadvantages of this technique for diagnosis of adrenal hyperplasia.
Advantages
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CT scan without contrast is able to visualize adrenal hyperplasia.
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CT scans are relatively quick imaging procedures that require minimal patient cooperation and are less susceptible to motion artifact.
Disadvantages
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Exposure to ionizing radiation
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Rarely, hyperplastic adrenal glands may appear nodular and mimic solitary or multiple adenomas.
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Metastatic diease, tuberculosis, and histoplasmosis may have a similar appearance.
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Half of biochemically hyperplastic glands may appear normal.
III. What are the contraindications for the first-line imaging technique?
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CT scanning is contraindicated in pregnant patients, especially within the first two trimesters.
IV. What alternative imaging techniques are available?
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Ultrasound
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MRI
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of adrenal hyperplasia.
Ultrasound
Advantages
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May demonstrate bilateral diffuse enlargement or multiple bilateral small nodules
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Relatively inexpensive
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Portable imaging modality
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Does not use ionizing radiation
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For pregnant patients, it is the first choice of imaging.
Disadvantages
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Technically challenging in the adult
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Limited evaluation in obese patients
MRI
Advantages
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MRI without contrast is able to identify bilateral adrenal hyperplasia.
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May be able to characterize adrenal adenoma
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There is no ionizing radiation exposure.
Disadvantages
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Expensive
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Time consuming
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Requires marked patient cooperation to limit motion artifact
VI. What are the contraindications for the alternative imaging techniques?
Ultrasound
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No significant contraindications exist.
MRI
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Hazards exist for patients who have ferromagnetic devices implanted in their bodies.
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