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The appearance of the adrenal glands on CT in multiple endocrine neoplasia type 1

S Whitley, Radiology, St. Bartholomew's Hospital, London, United Kingdom
V Moyes, Endocrinology, St. Bartholomew's Hospital, London, United Kingdom
K Park, Radiology, St. Bartholomew's Hospital, London, United Kingdom
A Brooke, Endocrinology, St Bartholomew's Hospital, London, United Kingdom
A Grossman, Endocrinology, St Bartholomew's Hospital, London, United Kingdom
S Chew, Endocrinology, St Bartholomew's Hospital, London, United Kingdom
A Rockall, Radiology, St. Bartholomew's Hospital, London, United Kingdom
J Monson, Endocrinology, St Bartholomew's Hospital, London, United Kingdom
R Reznek, Radiology, St. Bartholomew's Hospital, London, United Kingdom

Correspondence: Veronica Moyes, Email: v.moyes{at}qmul.ac.uk

Abstract

Aims: To review the morphology of the adrenal glands in Multiple Endocrine Neoplasia type 1 (MEN1) on computed tomography (CT), to compare the results with established normal values for adrenal size and nodularity and to correlate adrenal size with serum cortisol secretory dynamics.

Materials and Methods: Two observers independently reviewed the adrenal CT in 28 patients with MEN1, measuring the maximum width of the body of the gland and the medial and lateral limbs. Incidence and location of nodules >5mm within the gland were recorded. Following exclusion of known cases of Cushing’s syndrome, adrenal gland size was compared with previously documented normative data. Adrenal gland size was compared between patients with normal and abnormal cortisol dynamics.

Results: Comparison of mean adrenal size in MEN1 patients with normative data showed that the adrenal limbs were significantly larger in MEN1 than normal (p<0.0001 in all 4 limbs). Adrenal body was also significantly larger (p<0.05). Nodules were demonstrated in 18 (60%) of patients (vs 0.4 – 2% in the normal population). There was a trend towards an association between enlarged adrenal limbs and abnormal serum cortisol dynamics in those patients without confirmed Cushing’s disease, although the small numbers precluded statistical significance.

Conclusions: In patients with MEN1, adrenal limb hyperplasia and adrenal nodules are significantly more common than in the normal population, a phenomenon not previously documented in a quantitative manner. There is a trend suggestive of an association between adrenal limb hyperplasia and abnormal cortisol dynamics. No adrenal malignancy was demonstrated.