diagnostic imaging of the adrenal glands SDL

Question 1

what are the advantages and disadvantages of using radiographs to diagnose endocrinopathies

Answer 1

Unless pathology is very severe, unlikely to identify adrenals – certainly can’t measure them. May pick up mineralisation but a non-specific finding anyway. Can’t assess pituitary

Question 2

what are the advantages and disadvantages of using ultrasound to diagnose endocrinopathies

Answer 2

Needs skill. Adrenals can be measured and assessed for uniformity/nodules, symmetry/asymmetry

Question 3

what are the advantages and disadvantages of using CT to diagnose endocrinopathies

Answer 3

Needs specialist facilities but can image pituitary as well as adrenals

Question 4

what are the advantages and disadvantages of using MRI to diagnose endocrinopathies

Answer 4

Needs specialist facilities but can image pituitary as well as adrenals

Question 5

what are the abdominal landmarks used to localise the left and right adrenal gland

Answer 5

• celiac and cranial mesenteric arteries (left gland caudal, right gland cranial)
• cranial to renal artery
• phrenicoabdominal vein crosses mid portion of adrenal gland

Question 6

What signs can be seen on radiographs and/or ultrasound that might support your diagnosis of hyperadrenocorticism in a canine patient in the liver kidneys or bladder

Answer 6

**liver **Hepatomegaly
kidneys and/or bladder Bladder often full/enlarged (as with any polyuric condition) – rarely, immunosuppression results in emphysematous cystitis (gas bubbles evident in the bladder).

Question 7

what changes in adrenal size would you expect in PDH

Answer 7

bilateral symmetrical adrenal enlargement

Question 8

what changes in adrenal size would you expect in benign ADH

Answer 8

unilateral adrenal enlargement with contralateral adrenal atrophy

Question 9

what changes in adrenal size would you expect in malignant ADH

Answer 9

Unilateral adrenal enlargement with contralateral adrenal atrophy but perhaps with local invasion into blood vessels

Question 10

what canges would you expect to see in the adrenals in a dog with both PDH and ADH

Answer 10

Adrenal asymmetry but without contralateral atrophy (less dramatic asymmetry). Thankfully an extremely rare diagnostic dilemma

Question 11

in addition to HAC, what other pathological process can cause adrenomegaly

Answer 11

• Chronic stress
• Chronic stress on non-adrenal illness
• Phaeochromocytoma
• Non-cortisol secreting adrenocortical tumours
• Rare things like metastatic tumours, tuberculosis or other granulomatous lesions, congenital adrenal hyperplasia (more a human thing)