A series of noninvasive evaluations for bilateral adrenal tumor

Excerpt

We present an educational case of bilateral adrenal tumor. A 52-year-old woman underwent abdominal ultrasonography for screening purposes, which detected bilateral adrenal tumor. On non-contrast-enhanced CT, the left adrenal tumor had a low-density area indicating a fatty component (a). Contrast-enhanced CT revealed central necrosis in the right adrenal tumor (b). T2-weighted MR imaging showed that the right tumor had high intensity (c). The left tumor appeared with lower intensity on in-phase MR imaging (d) compared to out-of-phase MR imaging (e), indicating a fatty component. ¹²³I-metaiodobenzylguanidine (MIBG) highly accumulated in the right tumor with preserved physiological uptake in the left tumor (f). The left tumor showed high uptake of ¹³¹I-adosterol with no accumulation in the right tumor (g). These results of scintigraphy, consistent with CT and MR findings, suggested that the left tumor was an adrenocortical adenoma and that the right tumor was a pheochromocytoma [1]. Laboratory tests revealed elevated urine metanephrines but normal corticosteroids. …