Imaging the Adrenals

Question 1

3 arteries that supply the adrenal glands

Answer 1

Superior, middle and inferior suprarenal arteries

Question 2

3 zones of the adrenal cortex and what they make

Answer 2

Zona glomerulosa (aldosterone)
Zona fasiculata (cortisol)
Zona reticularis (androgens)

Question 3

What does the adrenal medulla make?

Answer 3

Epinephrine and NOR

Question 4

2 modalities mainly used for structural imaging of the adrenal glands?

Answer 4

CT and MRI (occasionally US)

Question 5

Is radiography useful in adrenal imaging?

Answer 5

Nope

Not visible unless they are very large, calcified or contain a large amount of fat

Question 6

What is the workhorse for adrenal imaging?

Answer 6

CT

Question 7

MIBG

Answer 7

NOR analog
Imaging the NOR reuptake mechanism
Label with I-123 (imaging) or I-131 (therapy)

Question 8

In-111 Octreotide

Answer 8

Somatostatin analog
Imaging SS receptors
Positive in a wide variety of tumors (including pheochromocytomas)

Question 9

F-18 FDG PET Imaging

Answer 9

FDG is a glucose analog
Actively transported into cells by glucose transport proteins
Effectively a marker or glucose metabolism

Question 10

DDx for Adrenal incidentaloma

Answer 10

Cortex: adenoma, nodular hyperplasia, carcinoma
Medulla: pheochromocytoma
Metastases: lung
Other: myelolipoma, cyst, hemorrhage

Question 11

Adrenal adenomas

Answer 11

Most common benign tumor of the adrenal gland
Often contains increased intracellular lipid
Increased washout of contrast compared to malignant nodes

Question 12

Adrenal metastases most often come from what 3 places

Answer 12

Lung
Breast
Melanoma (skin)