First page Back Continue Last page Overview Graphics
Notes:
Figure 2. Pheochromocytoma (Panel A), Benign Cortical Adenoma (Panel B), and Adrenocortical Carcinoma (Panel C). A heterogeneous (vascular), contrast-enhanced, right adrenal mass, 4.5 cm in diameter (Panel A, arrow), was incidentally revealed on abdominal CT in a 48-year-old woman who was being evaluated for possible appendicitis. The unenhanced CT attenuation was 40 Hounsfield units, and the contrast-medium washout was less than 50% at 10 minutes. The patient had no symptoms or signs of pheochromocytoma. Both urine and plasma normetanephrine levels were markedly elevated. She was treated with {alpha}- and beta-adrenergic blockade, and a pheochromocytoma was removed. A right adrenal mass (Panel B, arrow), 3.6 cm by 2.5 cm, was incidentally discovered on abdominal CT (performed because of diffuse abdominal discomfort) in a 62-year-old woman with normal blood pressure. The unenhanced CT density (-10 Hounsfield units) and the contrast-medium washout of more than 50% at 10 minutes were consistent with the presence of a cortical adenoma. Hormonal testing for subclinical Cushing's syndrome and pheochromocytoma was negative. The patient is being followed with repeated imaging and hormonal testing. A heterogeneous, contrast-enhanced, left adrenal mass (Panel C, arrow), 7.5 cm by 5.5 cm by 6.5 cm, was detected on abdominal CT after measurement of a minimally elevated level of 24-hour urinary 5-hydroxyindoleacetic acid in a 27-year-old woman who had flushing and loose stools. The unenhanced CT attenuation was greater than 10 Hounsfield units, and the contrast-medium washout at 10 minutes was below 50%. Hormonal testing revealed that the mass was nonfunctioning. A laparotomy was performed to remove the mass; the finding on pathological examination was adrenocortical carcinoma.