X-ray of the adrenal glands

Radiation methods provide significant assistance to the clinician in recognizing adrenal lesions. These glands are not visible on plain radiographs. Only in cases where Addison's disease is associated with tuberculous lesions of the adrenal glands, small deposits of lime are sometimes visible in the latter. In this regard, the simplest method of radiation examination is sonography. We will only note that normal or slightly enlarged adrenal glands are not always visible on sonograms.

On CT scans, the adrenal gland can be detected as a formation located above the upper pole of the kidney and slightly in front of it. A normal gland causes a small formation of oval or triangular shape with straight or convex contours. A tumor causes its enlargement and deformation. CT scans can detect tumors with a diameter of only 0.5-1.0 cm. MRI is considered an even more sensitive method, especially when detecting hyperplasia of the adrenal cortex (sonography and CT register hyperplasia in only half of patients). Adrenal scintigraphy has also been developed. It is performed by intravenous administration of 99mTc-MIBG. A normal adrenal gland forms a focus of RFP accumulation above the upper pole of the kidney. This technique is rarely used due to the significantly greater diagnostic capabilities of CT and MRI. However, it is useful in differentiating hyperplasia and a tumor of the adrenal gland. In adenoma, one adrenal gland is enlarged, in which a large amount of radiopharmaceuticals accumulates, while the function of the second is suppressed. In nodular hyperplasia, one adrenal gland is also enlarged and concentrates radiopharmaceuticals well, while the second is small in size and weakly accumulates radiopharmaceuticals.

Disruption of adrenal function manifests itself in various clinical syndromes and is characterized by specific laboratory data (Itsenko-Cushing syndrome, Conn's syndrome - primary aldosteronism, symptomatic hypertension due to the development of pheochromocytoma). The organic basis of Itsenko-Cushing syndrome is most often bilateral hyperplasia of the adrenal cortex (mainly due to the development of a pituitary adenoma), and Conn's syndrome - hyperplasia or tumor (usually benign adrenal adenoma). Accordingly, the tactics of radiological examination are built, in which CT occupies a leading place.

It is clear from the above that in Itsenko-Cushing syndrome, the examination should be supplemented with radiography, CT or MRI of the sella turcica in search of a pituitary adenoma. In addition, in this syndrome, radiography of the skeleton is performed. At a young age, bone growth slows down. Due to a violation of mineral metabolism, systemic osteoporosis occurs. Rib and vertebral body fractures are common, as well as aseptic bone necrosis.

The study of venous blood for the content of adrenal hormones is performed by catheterization of the adrenal veins using transfemoral access, followed by contrast venography and collection of blood samples from these veins and the inferior vena cava. The procedure is invasive and technically complex, and is performed in an angiography room. Testing of venous blood is a fairly reliable test for distinguishing between unilateral and bilateral hyperplasia and adenoma, as well as intra- and extraadrenal locations of pheochromocytoma.

Metastases of cancer are often detected in the adrenal glands. The sad primacy here belongs to breast and lung cancer, which must be taken into account during clinical and radiation examination of patients.