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

  • CT scan without contrast is able to visualize adrenal hyperplasia.

  • CT scans are relatively quick imaging procedures that require minimal patient cooperation and are less susceptible to motion artifact.

Disadvantages

  • Exposure to ionizing radiation

  • Rarely, hyperplastic adrenal glands may appear nodular and mimic solitary or multiple adenomas.

  • Metastatic diease, tuberculosis, and histoplasmosis may have a similar appearance.

  • Half of biochemically hyperplastic glands may appear normal.

III. What are the contraindications for the first-line imaging technique?

  • CT scanning is contraindicated in pregnant patients, especially within the first two trimesters.

IV. What alternative imaging techniques are available?

  • Ultrasound

  • MRI

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of adrenal hyperplasia.

Ultrasound
Advantages

  • May demonstrate bilateral diffuse enlargement or multiple bilateral small nodules

  • Relatively inexpensive

  • Portable imaging modality

  • Does not use ionizing radiation

  • For pregnant patients, it is the first choice of imaging.

Disadvantages

  • Technically challenging in the adult

  • Limited evaluation in obese patients

MRI
Advantages

  • MRI without contrast is able to identify bilateral adrenal hyperplasia.

  • May be able to characterize adrenal adenoma

  • There is no ionizing radiation exposure.

Disadvantages

  • Expensive

  • Time consuming

  • Requires marked patient cooperation to limit motion artifact

VI. What are the contraindications for the alternative imaging techniques?

Ultrasound

  • No significant contraindications exist.

MRI

  • Hazards exist for patients who have ferromagnetic devices implanted in their bodies.

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