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

¹ , Departments of Diagnostic Imaging² Centre for Endocrinology, St Bartholomew's Hospital, Barts and the London NHS Trust and QMUL, London, UK

(Correspondence should be addressed to R H Reznek who is now at Centre for Cancer Imaging, Institute of Cancer, Barts and The London School of Medicine and Dentistry, Dominion House, 59 Bartholomew Close, London EC1A 7ED, UK; Email: r.h.reznek{at}qmul.ac.uk)

^* (S A Whitley and V J Moyes contributed equally to this work)

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 >5 mm 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 four limbs). Adrenal body was also significantly larger (P<0.05). Nodules were demonstrated in 17 (60%) of patients (versus 0.4–2% in the normal population). No statistically significant correlation was demonstrated between adrenal limb hyperplasia and abnormal cortisol dynamics.

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 was no significant correlation between adrenal limb hyperplasia and abnormal cortisol dynamics.