Notes in 02 Adrenal glands

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Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsThe adrenal glands are {{c1::inverted Y-shaped::shape and orientation}} endocrine glands that mediate the stress …
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsThe adrenal glands are often asymmetric with the {{c1::left::right/left}} gland thicker than the {{c1::right::rig…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsWhat two distinct components comprise the adrenal glands?{{c1::Cortex (peripheral portion)}}{{c2::Medulla (centra…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsAdrenal Embryological OriginsCortex → {{c1::mesothelium}}Medulla → {{c2::neural crest}}
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsWhat are the distinct hormones synthesized by the adrenal cortex derived from?{{c1::Cholesterol}}
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsAdrenal Cortex LayersZona {{c1::glomerulosa}} (most superficial): produces {{c1::aldosterone}}
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsAdrenal lesions that can be diagnosed on imaging include adrenal {{c1::hyperplasia}}, {{c2::adenoma}}, and c…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsThe adrenal medulla is associated with {{c1::catecholamine}} production ({{c2::norepinephrine}} and {{c2::epineph…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsWhat is the most common extracranial solid tumor of childhood?{{c1::Neuroblastoma}}
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsWhat non-neuroblastic mass arises in the adrenal medulla?{{c1::Pheochromocytoma}}
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsNeuroblastic tumors that can arise from the adrenal medulla include {{c1::ganglioneuroma}}, {{c2::ganglioneurobla…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsMost incidental adrenal lesions {{c1::ARE NOT::ARE/ARE NOT}} hyperfunctioning
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsA patient may be supsected of having a {{c1::hyper-::hyper-/hypo-}}functioning adrenal lesion based on clinical s…
Published	05/01/2023	Genitourinary Imaging: Adrenal Glands{{c1::Cushing syndrome}} is caused by excess circulating {{c2::cortisol}} by exogenous administration or endogeno…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsWhat pituitary disease can cause Cushing syndrome?{{c1::Cushing disease}}
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsWhat non-pituitary diseases can cause Cushing syndrome?{{c1::Idiopathic adrenal hyperplasia}}{{c2:…
Published	05/01/2023	Genitourinary Imaging: Adrenal Glands{{c1::Conn syndrome}} is the result of excess aldosterone production, usually from an adrenal adenoma, resulting …
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsAdenomas implicated in Conn syndrome are typically small and may be difficult to detect on {{c1::CT}}
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsWhat diagnostic adjunct could help localize the side of excess hormone production from an adrenal adenoma?{{c1::V…
Published	05/01/2023	Genitourinary Imaging: Adrenal Glands{{c1::Adrenal cortical carcinoma}} is a very rare adrenal malignancy that arises from the cortex and typically ca…
Published	05/01/2023	Genitourinary Imaging: Adrenal Glands{{c1::Pheochromocytomas}} usually arise from the adrenal medulla and can be associated with excess catecholamine …
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsWhat clinical symptoms can result from a pheochromocytoma?{{c1::Episodic headaches}}{{c2::Tachycardia}}{{c3::Diap…
Published	05/01/2023	The adrenal glands are a site of {{c1::secondary sex hormone}} synthesis and {{c2::blood pressure regulation}} (with aldosterone)
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsSubstantial destruction of adrenal tissue is required to produce {{c1::adrenal insufficiency}}
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsWhat disease represents chronic adrenocortical insufficiency?{{c1::Addison disease}}
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsAutoimmune destruction of the adrenal glands or prior infection can cause {{c1::Addison disease}}
Published	05/01/2023	Genitourinary Imaging: Adrenal Glands{{c1::Waterhouse-Friderichsen}} syndrome is post-hemorrhagic adrenal failure secondary to {{c2::Neisseria meningi…
Published	05/01/2023	Genitourinary Imaging: Adrenal Glands{{c1::Idiopathic adrenal hemorrhage}} is usually unilateral and rarely causes adrenal hypofunction
Published	05/01/2023	Genitourinary Imaging: Adrenal Glands{{c1::Adrenal adenoma}} is a benign of the adrenal cortex
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsAdrenal adenomas are usually {{c1::incidental}}, but occasionally produce excess {{c2::aldosterone}} that results…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsTwo properties of adrenal adenomas that allow for imaging diagnosis:{{c1::Microscopic fat}}AND/OR{{c2::Rapid…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsThe best imaging study to evaluate for the presence of an adrenal adenoma is a(n) {{c1::adrenal protocol CT}}
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsAn adrenal nodule with attenuation ≤{{c1::10}} Hounsfield units (HU) on noncontrast CT can be reliably diagnosed …
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsThe percentage of adrenal adenomas that measure <10 HU on noncontrast CT is {{c1::70-80}}%
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsIV contrast is administered to assess washout characteristics if an adrenal nodule measures {{c1::>10}} HU on …
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsThe percentage of adrenal adenomas that measure >{{c1::10}} HU on noncontrast CT is {{c2::20-30%}} ({{c3::lipi…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsAn adrenal adenoma has a(n) {{c1::absolute}} washout >{{c2::60}}% or a(n) {{c1::relative}} washout >{{c2::4…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsAn adrenal nodule that DOES NOT meet {{c2::CT density}} or {{c2::washout criteria}} for an adenoma is consid…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsAn indeterminate adrenal nodule in a patient WITHOUT known malignancy represents a(n) {{c1::lipid-poor …
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsWhen is a diagnosis of an adrenal lesion required for further management?{{c1::History of cancer WITHOUT known me…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsIf diagnosis of an adrenal lesion is required for further management, workup is based on {{c1::lesion size}}, {{c…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsIf diagnosis of an adrenal lesion is required for further management, {{c1::FDG PET/CT::imagi…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsWhat is the term for the co-existence of two tumors within an adrenal mass?{{c1::Collision tumor}}
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsWhat is a common example of a collision tumor?{{c1::Metastasis within an adrenal adenoma/myelolipoma}}
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsCase: Adrenal MassYellow Arrows: {{c1::crescentic::shape}} lesion {{c2::posterolaterally::position}} with {{c3::s…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsA {{c1::collision tumor}} should be considered, even if a portion of the lesion attenuates <{{c1::10}} HU, in …
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsAdrenal {{c1::adenomas}} demonstrate {{c2::rapid}} washout characteristics while adrenal {{c1::metastases}} demon…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsThe adrenal protocol study consists of three phases: {{c1::unenhanced}}, {{c2::enhanced (60 seconds post-injectio…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsAn {{c1::adrenal adenoma}} is diagnosed and the exam is terminated if an adrenal nodule measures <{{c2::10}} H…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsIf an adrenal nodule measures >{{c1::10}} HU on {{c1::noncontrast CT::study}}, {{c2::IV contras…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsWhat absolute washout percentage on adrenal washout CT is diagnostic of an adrenal adenoma?{{c1::>60…
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Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsCase: Adrenal Washout CTFindings: Axial {{c1::unenhanced::first image phase}}, {{c1::enhanced::second i…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsWhat relative washout percentage on adrenal washout CT is diagnostic of an adrenal adeno…
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Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsIn a patient with a known primary malignancy, adrenal lesions that do not demonstrate benign washout kinetics are…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsLipid-rich adrenal adenomas contain {{c1::intracytoplasmic}} lipid
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsSmall amounts of intracytoplasmic lipid in lipid-rich adrenal adenomas that may be undetectable by {{c1::CT:…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsMRI takes advantage of the fact that {{c1::protons}} resonate at different frequencies in {{c2::fat::substance}} …
Published	05/01/2023	Genitourinary Imaging: Adrenal Glands{{c1::Chemical shift}} imaging consists of paired GRE images obtained at different {{c2::echo times (TEs)}}
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsTwo different echo times (TEs) used in chemical shift imaging:{{c1::In-Phase (IP) and Out-of-phase (OOP)}}
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsChemical shift imaging = in-(IP) and out-of-phase (OOP) imagingSituation: {{c1::Fat::substance}} and {{c1::water:…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsAdrenal adenomas {{c1::suppress::do not suppress/suppress}} on out-of-phase (OOP) images, while metastases genera…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsCase: Adrenal Mass on Chemical Shift ImagingYellow Arrows: Axial MRI demonstrates signal {{c1::dropout::signal ch…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsFour malignant adrenal masses that may contain intracytoplasmic lipid and lose signal on out-of-phase chemical sh…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsCase: Role of Biopsy in Adrenal MassLeft Yellow Arrow: {{c1::Fused axial PET-CT::imaging study}} in a patien…
Published	05/01/2023	Genitourinary Imaging: Adrenal Glands{{c1::Percutaneous::route}} adrenal mass biopsy is a safe procedure often performed under CT guidance and {{c2::i…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsAn adrenal mass that remains indeterminate after comprehensive imaging workup, particularly in the context o…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsCase: {{c1::Adrenal myelolipoma}}Yellow Arrows: Axial (left image) and coronal (right image) CT shows a predomina…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsA(n) {{c1::adrenal myelolipoma}} is a benign neoplasm consisting of {{c2::myeloid}} cells (i.e., {{c3::erythrocyt…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsAdrenal myelolipomas can rarely be {{c1::extra-adrenal::location}} and are pathologically indistinguishable from …
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsA(n) adrenal mass with {{c1::macroscopic (gross)::macro-/microscopic}} fat is virtually diagnostic of a(n) {…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsWhat adrenal mass is usally an incidental finding and can be large (>4 cm) at the time of diagnosis?{{c1::Adre…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsWhat large mass can mimic an adrenal myelolipoma but typically displaces, rather than arises from, the …
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsTwo rare adrenal masses that have exhibited macroscopic fat (myelolipoma mimics):{{c1::Adrenocortical carcinoma, …
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsAn adrenal myelolipoma should not be confused with a {{c1::renal angiomylolipoma (AML)}}, although both are …
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsAdrenal cysts are relatively {{c1::uncommon::uncommon/common}} and have typical benign cysts imaging characterist…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsThe most common type of adrenal cysts are {{c1::endothelial::type}} ({{c1::45}}%) and may be {{c2::lymphatic}} or…
Published	05/01/2023	Genitourinary Imaging: Adrenal Glands{{c1::Pseudocysts}} secondary to {{c1::adrenal hemorrhage::cause}} represent {{c2::39}}% of adrenal cysts
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsThe rarest subtype of adrenal cysts are {{c1::epithelial cysts}} ({{c1::9}}%)
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsWhat is the next best step to differentiate a complex adrenal cyst from a cystic/necrotic neoplasm?{{c1::Percutan…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsWhen can an adrenal cyst be ignored?It is {{c1::small}}, {{c1::asymptomatic}}, and {{c1::simple}}
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsAn adrenal cyst may rarely grow so large as to cause symptoms, such as {{c1::dull flank/abdominal pain}} or compr…
Published	05/01/2023	Genitourinary Imaging: Adrenal Glands{{c1::Hydatid disease}} may rarely affect the adrenal glands, producing a(n) {{c2::complex cystic}} lesion with a…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsCase: {{c1::Pheochromocytoma}}Yellow Arrows: Contrast-enhanced axial (left image) and coronal (right image) CT sh…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsA pheochromocytoma ({{c1::intra-adrenal paraganglioma::alternate name}}) is a neuroendocrine tumor that typically…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsPheochromocytomas are composed of {{c1::chromaffin cells}} that secrete {{c1::catecholamines}} (cause {{c2::uncon…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsApproximately {{c1::90}}% of pheochromocytomas are {{c1::benign::malignant/benign}}
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsPheochromocytomas can be {{c1::large::size}} and {{c1::heterogeneous::composition}} due to areas of {{c2::necrosi…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsPheochromocytomas demonstrate {{c1::avid::avid/no}} enhancement on CT
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsOn MRI, pheochromcytomas demonstrate marked T{{c1::2}} hyperintensity ({{c2::light bulb sign::sign}}) a…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsWhat four imaging modalities can be used in the detection of extra-adrenal pheochromocytomas?{{c1::Nuclear medici…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsWhat clinical context is imaging (e.g., Iodine-123 MIBG, Indium-111) recommended in the detection of ex…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsPheochromocytoma/paragangliomas are associated with several syndromes:{{c1::Multiple endocrine neoplasia (MEN) 2A…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsThe most common site of an extra-adrenal paraganglioma is the {{c1::organ of Zuckerkandl}}, located along the {{c…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsWhen an extra-adrenal paraganglioma involves the bladder, it can produce a distinctive clinical presentation of {…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsParagangliomas of the head and neck are generally called {{c1::glomus tumors}} and may be associated with the:{{c…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsIn theory, pheochromocytoma/paragangliomas should be diagnosed by {{c1::urine/plasma catecholamines}} and {{c1::m…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsIn clinical practice, the first line imaging test to rule out suspected pheochromocytoma (i.e., {{c1::adrenal mas…
Published	05/01/2023	Genitourinary ImagingCase: Flank MassYellow Arrows: Multiphase CT shows a(n) {{c1::avidly enhancing::characteristics}} {{c2::left adrenal::location}} …
Published	05/01/2023	Genitourinary ImagingCase: Complex Abdominal MassYellow Arrows: Axial (left image) and coronal noncontrast CT demonstrates a large, complex mass …
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsAdrenal cortical carcinoma is a very rare malignancy with a prevalence of approximately {{c1::1/1,000,000}}
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsApproximately {{c1::66}}% of adrenal cortical carcinomas are functional, producing a disordered array of hor…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsWhat malignant adrenal mass presents as large and heterogenous with internal necrosis and hemorrhage as typical f…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsAutopsy studies show that adrenal metastases are present in >{{c1::25}}% of patients with a(n) {{c1::known pri…
Published	05/01/2023	Genitourinary Imaging: Adrenal Glands{{c1::Primary adrenal lymphoma}} is rare but should be suspected in the context of {{c2::splenomegaly}} and/or {{…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsAdrenal hyperplasia is caused by a(n) {{c1::prolonged stress response}} or {{c1::ectopic ACTH secretion}}
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsAdrenal hemorrhage can be spontaneous but in adults is usually due to {{c1::anticoagulation}} or a(n) {{c1::under…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsAdrenal hemorrhage may appear {{c1::mass-like}} and is often {{c1::heterogeneous::homogeneous/heterogeneous}…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsWhat adrenal pathology should be suspected in the event of rapid onset adrenal mass when prior imaging is av…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsFollow-up imaging can be helpful in rapid-onset adrenal mass to {{c1::confirm resolution}} and/or {{c1::interval …
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsCase: Rapid-Onset Adrenal MassYellow Arrows: Multiphase adrenal protocol CT demonstrates a {{c1::heterogeneo…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsCase: Adrenal MassYellow Arrows: Axial contrast-enhanced CT shows a {{c1::coarse calcification}} in the {{c2…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsAdrenal calcifications rarely cause adrenal {{c1::hypofunction::hypofunction/hyperfunction}}
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsAdrenal calcifications can be due to:{{c1::Adrenal hemorrhage}}{{c2::Granulomatosis with polyangiitis::autoimmune…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsAdrenal Cortex LayersZona {{c1::fasciculata}}: produces {{c2::glucocorticoids}} in response to pituitary {{c…
Published	05/01/2023	Genitourinary Imaging: Adrenal GlandsAdrenal Cortex LayersZona {{c1::reticularis}} (deepest; closest to adrenal medulla): produces {{c1::and…
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