Adrenal incidentalomas :

 Adrenal incidentalomas :

Adrenal Adenoma

Clinical Features

ACTH independent Cushings Syndrome :

Hypertension

Adrenal Adenoma

Impaired Glucose tolerance

Hirsutism

Amenorrhea

Elevated urine 24 hours cortisol / creatinine ratio

NORMAL RANGE IS 0 – 25

Undetectable levels of serum ACTH : less than 1 milli units / L ( Normal range : 2 – 20 )

Lack of cortisol suppression with dexamethasone administration ( serum cortisol of  561 nmol / l after 2 days of dexamethasone 0.5 mg)

Good effect with laprascopic resection

Ct Abdomen : adrenal adenoma / lesion with density of 40 HU : Hounsfield Units

Adrenal mass / incidentaloma

Main aim is to determine if its benign or malignant

Size is one clue : 90 % of adrenal carcinomas are more than 4 cm in size / diameter .

However 70 % of incidentalomas more than 4 cm in diameter were fund to be benign

Hence other features should also be taken into account

The most important diagnostic clue is density of the lesion on a non contrast CT scan in Hounsfield Units

If the adrenal incidentalma has a density of less than 10 HU on non-contrast scan , it is certainly a benign lesion.